Change Your Brain Every Day - How Improving Brain Health Can Change The Way You Look, Feel, and Thrive with Dr Andrew Newberg and Dr Daniel Monti

Episode Date: July 9, 2021

 Dr Daniel Amen sits down with colleagues and friends Dr Andrew Newberg and Dr Daniel Monti to talk about their upcoming collaborative book Brain Weaver: Creating the Fabric for a Healthy Mind through Integrative Medicine.

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And I'm Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain spec imaging to personalize treatment to your brain. For more information, visit amenclinics.com.

The Brain Warriors Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com. Hey, everybody. I am so excited about this episode, and we're going to do it a little bit differently. Rather than cut it up into four, we're just going to have one big episode. I am here with my friends, Dr. Andrew Newberg and Daniel Monti from the Bernie Marcus Institute of Integrative Health. And Andrew and I have been friends for a long time and we have published many papers together. And I am just so excited about their new book, Brain Weaver, creating the fabric for a healthy mind through integrative medicine. And why I'm so excited about it, besides I get to hang out with friends, is I think at Amen Clinics, we have worked to pioneer three big ideas. That imaging, if you don't look, you don't know.

We need to stop lying about that. That, you know, we have to stop being the only medical specialty that never looks at the organ it treats. That's insane. Natural ways to heal the brain in an integrative or functional medicine context. Your brain is an organ like your heart is an organ. And if your gut's not right, your brain's not right. If your heart's not right, your brain's not right. If your immune system's not right, your brain's not right. If your heart's not right, your brain's not right. If your immune system's not right, your brain's not right. And so they just released Brain Weaver,

and I just couldn't be more excited about it. The foreword is by Bernie Marcus, who's a philanthropist who's involved in starting Home Depot. And tell me, Dan and Andrew, why this book? Why now? Well, first of all, thank you for the great introduction. And thanks for all of the work you've done to lay the groundwork for a lot of the work that we do. And I think we've reached this moment in time where all of us need to be getting that same message out there. And we have this tremendous opportunity. So as you mentioned, we're the Marcus Institute of Integrative Health at Thomas Jefferson University. But also in the last year or so, we were able to create the first ever department of integrative medicine at a medical school in the country. So not just a program, not just a center, but we are the department of integrative medicine

and nutritional sciences. I actually get to be a department chair and sit alongside the chair of medicine, surgery, OBGYN, dermatology, and now integrative medicine. This historic first really is the culmination of all of the things that people like you, Andy, and all of us have been doing for years to be able to finally have that academic recognition that there's something that we're doing that adds value to the medical treatment plan. And so when we think about that in terms of brain health, all of the research that's been going on and a lot of the research that Andy and I have done together at the Marcus Institute here at Jefferson.

There's a story to tell about what the imaging shows when you do an intervention, why the imaging is important. So we have a lot of those pre-post scans using functional MRI or PET scan imaging, even SPECT imaging, and how you can actually transform the way you think, feel, look, and thrive through some of the techniques and tools that we've cultivated, that all of us have been proposing. And as you said, Dr. Amen, by looking at the imaging. You know, when I read the table of contents, I'm like, it reads like many of my books about diet and toxicity and sleep and spirituality and exercise. And you're right, the more we get this message out. And, you know, one of my pet peeves is people go, oh, you're into alternative medicine. I'm absolutely not into alternative. I'm into good medicine. Virtually everything you do and everything you talk about in Brain Weaver is in Harrison's textbook of medicine. That this is an alternative.

It's just we're integrating too often, you know, psychiatry is siloed from surgery, from oncology, from cardiology. And it's like all of this works together with the person in front of you. And that's why I think psychiatry just has this disaster that it has created where the 15-minute med check really replaced good medicine. When I trained in the early 1980s at Walter Reed, we were not taught to be the candy man. You know, I'm not the pharmaceutical rep. I'm their physician, which means I have to have a whole person approach. Daniel, I just want to echo what both of you have been saying and just emphasize it even

more that I think one of the phrases that I hear said all the time is that there isn't alternative medicine, integrative medicine, medicine. There's medicine. I mean, we all are doing the same thing, but what has been so woefully lacking from the majority of how people have been treated in the medical community, and especially in the psychiatry world, is how we can do that in a very comprehensive way by taking into consideration all of the dimensions of who a person is. So we recognize that the biology of what you are is absolutely essential. And things like diet and nutrition, and occasionally even medications when you need to,

are all relevant. But thinking about the psychological piece of this and how all of our biology and psychology fit together, and then the social and the spiritual part as well. I mean, all of these things need to be taken into consideration for each person individually. And I think, again, as we certainly do, and as I know you do, to individualize that care based on all of the information that we have, and based on what we understand about evidence-based practices. So let's take apart each of these four big circles. You know, whenever I see a new patient, I go to my whiteboard and I draw four big circles.

And I'm like, if I'm going to understand you and why you're here today, I need to understand the biology. So why we do labs and it's why we image. You know, I want to know about the physical functioning of your brain and body. What's the psychology, how you think, your development, the social circle who you hang out with, your stress is just coming out of the pandemic. This is social nightmare for people and a social blessing. We had more time with our families than we have in 60 years, probably. And then what's the spiritual circle? And a lot of people go, oh, no, you're a psychiatrist. You can't talk about spirituality. It's like, but all of my patients have a spiritual foundation.

Don't you think we should talk about why you think you're on the planet? Why do you breathe? Why do you want to be well? Sort of the why circle. So let's pull this apart. And you do this so beautifully in Brain Weaver. So what do you think are the most important biological contributors to brain health? Well, I certainly think that, you know, nutrition eliminating the foods that are creating problems with their biology, foods that are pro-inflammatory, foods that have a lot of carbohydrates, foods that have a lot of the bad oils and fats.

You're not going to be able, those are the building blocks of what your brain is going to do. So that to us is always absolutely fundamental. But we also need to understand the other aspects of the biology of the person and the other medical conditions that they may have, medications that they may be taking, all the different things that go into the biological component of who they are. So it's important to be very comprehensive with people. And one of the

things that we also talk a lot about, and we can talk about this in Brain Weaver, is that people need to actually think about where their strengths and weaknesses are when it comes to each of these dimensions, and particularly the biological ones. Maybe their gut health is really good. Maybe their gut health is really bad. And so if somebody is depressed and their diet is fantastic, then we have to look at other causes of the biology of what's going on. On the other hand, if their diet is a mess and they're depressed, then that's going to be the first thing that we start out with. So I think people also really need to try to figure out where their strengths and weaknesses are. We try to help people

through that process by asking them a lot of questions and trying to get people to reflect on who they are as a person. Dan, do you want to add anything? I'd say that, you know, when we talk about these four circles, and, you know, I love that you put it that way, we, you know, we think that way. One mechanistic principle that makes sense to think about, because oftentimes it helps patients to sort of think about some mechanism that weaves them all together, so to speak, if I can play on the words, is inflammation. And so as we think about inflammation as a principle that actually fuels almost all of the illnesses that we think about, especially once we reach adulthood, certainly cognitive decline, even Alzheimer's disease, then these different dimensions all affect the inflammatory levels in the body.

And so as Andy was saying, diet, certainly gut health, certainly. And so when people talk about a gut brain connection, what is that connection? You know, it's not some like chain connecting the gut to the brain. It's really a biochemical connection and a neurochemical connection. And the state of the gut and the food that we put in the gut has a direct impact on inflammatory factors and things that make their way to the blood-brain barrier, cross over, and affect the brain then, and how well the brain does or how compromised the brain gets. And when we go to that psychological domain, the same thing is true. If we think about it in terms of the autonomic nervous system, which, you know, maybe an easy

way to think about it is the fight or flight or restoration and recuperation branches of the nervous system, that fight or flight is all about keeping us alive, protecting us whenever there's any type of perceived threat to our well-being. It doesn't even need to be life-threatening. Just a perceived threat to well-being will activate the sympathetic nervous system, the fight or flight nervous system. And what that does has a whole cascade of downstream effects from increasing the demand on different organ systems to increasing those same inflammatory chemicals that have receptor sites on our immune cells. So being in that fight or flight or overly activated mode has a direct impact on inflammation, just as diet has a direct impact on inflammation. And so when we look at

that circle of the psychological, as you mentioned, Daniel, we're coming out of a pandemic where many people were in an activated state the entire time. And so that has severe consequences for some people. And that's why a lot of people really struggled and people's moods really struggled and how they felt physically really struggled. Because if we think about why we're hardwired to do that and go back to a time where maybe we saw a lion in the distance, we want to automatically go into that fight or flight mode. What does that mean? That means the nervous system activates itself to survive. So there's blood is pulled from the gut to the periphery so that we can fight or run. The nervous system reacts in many instances,

become hypervigilant. And so the idea is you make your way to safety versus if it's fight or flight, if it's a lion, hopefully you're smart, you choose flight, you climb up a tree, the lion passes and the nervous system is supposed to reset itself and go back into that

homeostatic state where we have some restoration and recuperation going on. But the lions of today are replaced by a pandemic, economic uncertainty, kids that have to be homeschooled, concerned about parents or loved ones who might have been vulnerable all through the pandemic, so that there's always that ongoing perceived threat to well-being, keeping people in that fight-or-flight mode. And if you think about that hardwiring, so the hypervigilance, people say they can't sleep, they can't calm their nervous system down. Oftentimes they complain of GI distress and, you know and nausea or dyspepsia or those kinds of things. Well, the gut is shutting down when you're in that fight or flight mode. The aches and pains,

well, that's because the energy is pulled in that direction and we get lactic acid built up and things like that. So there's this biological explanation for this psychological arousal that's going on. And inflammation is at the downstream end of it all, kind of weaving its way across these different dimensions. So you're in a more inflamed state and all of the other consequences that go with it. So one of the things that we talk about in the book are what are the tools that you can learn and incorporate to dampen that fight or flight response, to actually change the way you perceive the environment so that that sympathetic nervous system overactivity isn't going on all of the time. And what we also show in the book are

things from our clinical trials where we've taught people to do that, and the brain changes. How the brain reacts to stressors changes. We show that in the brain scans. How the brain talks to itself changes. How the brain coordinates emotional information changes. And that's really the positive news. The good news of the day is that this approach can have a dramatic response. And we get to see that response back to one of your original statements, Daniel, in the brain imaging itself. And then all of the other things that we measure from autonomic nervous system reactivity to inflammatory markers to other things that we can look at to complete that sort of mind-body picture. Take spirituality.

No, I'm just thinking that one, this should be taught in schools. It's like, why do you have to be sick before we actually teach you to be well? We have a high school course that's in all 50 states and it decreases drug alcohol and tobacco use, decreases depression and improves self-esteem. Why? Because we teach people to love and care for their brains. I mean, isn't it interesting that nobody really loves their brain? Because you can't see it. You can see the wrinkles in your skin or the fat around your belly and you can do something when you're unhappy with it but it's how i fell in love with my brain 1991 when i ordered my first spec scan i'm like oh that's not good because i already knew good versus not good and i've worked for 30 years to make it better so how do we transmit this information to the people who need it most, which is like our society, right? From February of 2020 to August, depression went from 8.5% to 28%, right? It's almost more normal to have anxiety, depression, addiction, ADHD. It's almost more normal to have a problem than not to have a problem.

So how do we, and yes, I think books are amazing. And I love this new book from both of you. How do we transmit that to the people who need it, which is really the general population. Well, I think it's a multifactorial process. As Dan was saying, I think part of what we're excited about is having a department of integrative medicine because I think a lot of the education starts with the healthcare providers. We go and I teach a class on nutrition to the medical students each year. And I get the same response every time I do it. I go in and I don't just say people need to eat better. People need to eat lower, you know, lower carbs.

We get into the details of it. And they always say, you know, we've been getting taught every time that we discuss heart disease or diabetes that patients need to eat better, but they never tell us how to tell them to do that. So I think part of it starts with the healthcare providers and people like you and ourselves in our department. We're hoping that this is a chain reaction. We're hoping that dominoes will fall and we'll get that information into the medical community more effectively. Certainly people like yourselves and the books that we all can do get to the larger community as well. And hopefully as we do more research, which has been a very prominent part of my work, and I know Daniel, you and I, both Daniels and I have done a lot of great research, getting that information out into the world to show people what's going on in the biology of the brain and the ways in which

we can help that, as you said, to start by just staying healthy in the first place. I think that those are some essential starting points. The more we can talk about it, the more we can get out there, the better our overall society will be. And then, you know, you mentioned in the beginning, thank you for acknowledging, you know, the tremendous contribution of people like big philanthropists, like Bernie Marcus, who gets that that message is important and so empowers us with a department and the ability to do these types of educational programs, because otherwise it would be very hard to do because the rest of the medical infrastructure isn't going to support it just yet. And so where does where do the resources come from? And so we're very grateful that people like Bernie Marcus and the Marcus Foundation have contributed to this cause that we're talking about,

because, as Andy was saying, we get to educate the medical students. Now, the other thing we do is we have begun launching major national CME events. And this is also a heads up that we'll be hitting you up to be the, you know, the keynote speaker at one of our upcoming MindBody Medicine CME events. So if we ask you on the podcast, maybe it'll be harder to say no when it comes around. But again, these are for healthcare providers across the board, physicians, but also nurses, chiropractors, physical therapists, other people who benefit from these educational programs and see events.

And so to be able to launch this type of educational series and programs for healthcare providers is a little bit of pushing a boulder uphill, but we get to do it because we have the support to do it. And that's one of the reasons we were so excited to write a book so that we could tell people, hey, this is going on. And the book is one of the tools of getting the word out there, just like the educational programs and just like providing the clinical programs and the clinical trials that Andy was talking about that we do and that we know you do, Daniel.

Those clinical trials give people access to something that they would have never even known about before. And then to be able to publish and get those publications out there. One of the things that we all need to get better at, at least on my end with Andy and me, is also accessing what people are listening to so that, you know, social media channels, things like things like this podcast, where the story, the message gets out there to people because a lot of people don't know. And a lot of people, if you say, oh, you know, we run an integrative medicine shop, we get the reaction you get. Is that alternative medicine? No, we never use that word. You know, we're looking to add value to the great medicine that's out there. There's, you know, the medical model we have is very good at addressing disease. It's very poor at addressing wellness. It's not so great at reducing modifiable risk factors of disease, but putting out the fire acutely, hey, that's where we shine. But where there's a big gap

is what we're trying to sort of fill. And by the way, one thing I'll just add about populations of people, to answer your question, Daniel, is children. That's ultimately where it starts. People develop those habits young. And that's why we see so many patients who come in when they're 60 and they, you know, they have a horrible diet and they're overweight.

And I mean, that's hard to change all of those habits that they've been dealing with and developing for 60 years. And, you know, if we can get down to the level of children and schools, and we're actually partnering with a couple of the restaurant companies in the Philadelphia area as a starting point to be able to teach kids how to cook, how to cook properly, how to cook healthy, how to make sure that you, you know, teach them about vegetables and things like that. And, and it's, it's starting to work. And I know you've done some great work with the Daniel plan and getting into churches and so forth um you know again trying to get people at that gut level at that at that

base level and uh and really trying to change the habits of people uh as early as possible that's where it's going to these seven sort of big neuroscience principles of happiness. And number four is choose foods you love that love you back. Because ultimately, you're in a relationship with food. And I don't know if either of you have ever been in a bad relationship. I have been, and I'm not doing it anymore. I'm going to be 67 next month. No, I'm not doing that anymore. And I'm damn sure not doing it with food. And so I used to be in love with Rocky Road ice cream that was abusing me with, you know, the bad fat the sugar, pro-inflammatory, as you guys talked about. And just that mindset of I'm in a relationship with food and I need to choose wisely,

or I could end up addicted to something that hurts me. So, yeah, so much of this I love. Let's talk about the spiritual circle because I know, Andrew, you and I published a study on a kundalini yoga, Kirtan Kriya, that after eight weeks of doing it every day, they had stronger resting prefrontal cortex function. Part of the reason we met, you were in the movie, What the Bleep Do We Know?

And you're also doing, you're showing spec scans and some of your early research. Oh, just as an aside, I think, Andy, I sent you the Canadian Association of Nuclear Medicine Guidelines for spec. It's as if I wrote them. I'm telling you, I'm so happy about that, that when you write down the 20 happiest moments of your life, that's probably in the top 10. I'm so happy. It's starting to change. It's, you know, that's how we have to do it. Yeah, no, I'm so excited about it. But, you know, that's sort of how you and I met. Can you talk about in Brain Weaver, how you both address the spiritual circle? Well, I think it is very important for everyone, just like with their biology, to sort of take a little bit of stock of who they are as a person.

What is their spiritual beliefs? Where do they come from? Where do they want to go? All of this is very important because if your spirituality is deeply related to your brain, and we've done those scan studies to show that practices like meditation, prayer, even just being a spiritual or religious person can have an influence on how your brain functions. And then that ultimately translates into your psyche, into your psychology of being, if you are, if you, if you have a spiritual tradition that teaches love and compassion,

then you are someone who has the neural circuits that foster those kinds of beliefs and experiences and behaviors. And then you go forth and you continue to express a sense of compassion, love and happiness and so forth, not only for yourself, but to the people around you. So, you know, there are thousands of different paths. And that to me is also always a key piece of integrative medicine, as we all discussed, that it still has to be that individualized piece. Everybody has to find the path, the journey that works best for them. But we are learning more and more about the unbelievably complex biology of what goes on in the brain, the emotional centers

of the brain, as you said, the frontal lobe, the concentration areas of the brain, that all can work more effectively, more efficiently, just by being someone who embraces a spiritual path. And even for people who are not religious, we always talk about the fact that there are a lot of opportunities from that perspective as well. Creative outlets, music, art, literature, being in nature, doing things that are good for the community, for your fellow neighbors and so forth.

All of those are wonderful ways of engaging that spiritual side of yourself that changes your brain and changes how healthy you are and changes your well-being. So one of the questions in the happiness challenge was the strategies live each day based on clearly defined values, purpose, and goals. And then the question is, does it fit? Does my behavior fit the goals I have for my life? I've often just been shocked when I ask people,

tell me what you want, what are your goals? They talk about work and money. They never talk about their relationships or their deepest sense of meaning and purpose, having strategies. And people go, well, that's not really the doctor's job. And I'm like, no, it's sort of the doctor's job. If we're going to deal with whole people, you have to know what motivates them. Absolutely. And one of the things that I've talked about in some of my other work, we call it the inner values exercise and ask people to reflect on those inner values. And as you said, a lot of times people start out very, very materialistically.

And and if you get them to engage in various spiritual practices, meditation, and so forth, we've actually documented the fact that those inner values can change. They can become values that have to do with things like love, compassion, family, and so forth. And then one of the important aspects of focusing on those inner values, as we said, are people sort of living through them? So if love is one of your inner values, are you loving yourself? Are you loving the people around you? If respect is an inner value, are you respecting yourself? Are you respecting the people around you? So we try to help people to kind of work with the values that they have, those really important ones, those spiritual ones

that can be so helpful and can really enable them to be the kind of person that they want to be and to be the healthy kind of person that they want to be so ed jefferson how does the department of psychiatry work with you and And do they embrace your work or ignore it or somehow see it as a threat? I'd say that it's a work in progress because the leadership of the department has changed, although the previous person was open to some dialogue. You know, psychiatry is stuck in a kind of paradigm, as you well know, and it's hard for people to think outside of the paradigm when they're treating patients. What I would say, I have this kind of joke that Andy knows, which are the Marcus Institute, we treat about three or four Jefferson chairs, department chairs that come to us for care. But in their clinic, I'm not sure that they've sent us three or four patients. Now, it's fascinating send us a family member or something like that but when they're in the mode of the way they practice it's as if they become completely disconnected from us because that

training and that paradigm is just so ingrained and so we do our best to make the inroads that we do and one of the ways that I think we do it the most effectively is to kind of go for the people in training because they're the most receptive. They're the ones that want to learn the most. You know, the famous chemist from the 1800s, Rutherford, Lord Rutherford, he was giving a graduation speech. And he said to the, you know, graduating class, when you come up with a really brilliant paradigm shifting idea, don't come back here. Because that's where it'll die. Back to the university, you know, where that paradigm is stuck in where it is. And so, but where we're really seeing that change. So for example, in the department, one of the things we were able to do, since there's now a board for integrative medicine, we were, it was one of the

reasons we were able to create a department. In this past year, we created a fellowship so that people graduating from a residency and something else can spend one year with us, which then is approved by the American Board of Medical Specialties Board for Integrative Medicine. And we run it just like an accredited board approved fellowship, whether if it were cardiology or a neurological subspecialty. So we abide by all that criteria. It's run through the house staff office. They're paid like fellows. And so it's this first kind of true fellowship in integrative medicine.

I tell you that background because you asked about psychiatry. So our first fellow currently is in family medicine and she's graduating. And so we opened up two slots starting July 1st, the new academic year. And one of the fellows is the current chief resident of psychiatry. So that person applied to then do an additional year with us in integrative medicine. Her chair gave her a glowing letter of recommendation. The head of outpatient services for psychiatry personally called me and said, you should take her. She's great. She'll help you move your field forward. So I think that there's cracks in the old paradigm. And I think that one of the ways that we like doing at Jefferson. Again, it's a slowly evolving change, but we see the change.

So what we need to do is help other places around the country start departments and over time get this thing moving along. But we do see those changes occurring. It's the future. No question. A long time ago, I read The Structure of Scientific Revolution by Thomas Kuhn. In fact, in my book, The End of Mental Illness, I go through the five stages. First, someone sees there's a problem. And then the powers that be try to fix it by making minor

changes. Think of the DSM. There's been six versions of the DSM. And DSM-5 is no different than DSM-3. It's the same thing. It's sort of a political shenanigan. It might be worse. In my mind. And then the third one is somebody comes up with a new idea you know look at your brain get your brain right and your mind will be better oh your brain's an organ like your heart's an organ stop just drugging the brain and get their diet right and get them to exercise and not believe every stupid thing they think. And step four is the most reliable stage of all of it, which is the rejection of it. And then step five, because the leaders of the old guard die and young people come on, is the acceptance. And I would argue that this new model of psychiatry is at about 4.6,

that it's close, that if you and I, the three of us continue to do what we're doing, we're going to see the revolution in our lifetime. Our 10 clinics are crazy busy. And we basically have four integrative medicine, 40 integrative medicine psychiatrists. And we just love how we practice, which is why I love your book, Brain Weaver. It's out now and people can get it. Where can they get the book? Amazon. It could come to our website, brainweaver.net. Barnes and Noble,

but just Amazon is the easiest way. We have a lot of physicians who listen to this podcast. How can they learn more about the work you are doing? Our website, we've taken a lot of time. It's a very unique website for being at an academic health center because we spend so much time on it, which is not typical of a department. And the institution has been very supportive of us knowing that we're a new specialty. And so marcusinstitute.jeffersonhealth.org, I know it's a mouthful, marcusinstitute.jeffersonhealth.org has all of the training programs that we have available,

the CME events, the certificate programs, the things that we have available for students, graduating residents who might wanna do a fellowship program and an ongoing blog. So I think that that would be a great resource to start with. And Andy and I, for physicians out there that have questions or wanna know more, we make ourselves personally available.

And there's also, you know, another dozen or so faculty that are working with us, but we take educating our fellow physicians very seriously, and it's a top priority of ours. Well, I'm so glad to have the opportunity to talk to both of you. Any final words before we have to stop for today? I'll say one thing and then Angie, please, I think you should conclude as the lead author on this terrific book. But the essence of this book is what we do at the Marcus Institute and in our department at Thomas Jefferson University. And we've created a brain health program that is just recently launched for veterans who have traumatic brain injuries.

And we were able to get a grant from the Gary Sinise Foundation Avalon Fund to provide a comprehensive two-day assessment that has the brain imaging and has all of the other components of a true functional model of care and assessment so that we understand where these people are. Most of them have had care, but it's very fragmented. They haven't had somebody put the picture together. This is such a priority program for us that Andy spends the time to be the medical director of this program. And, you know, we're all stretched with a lot of things, but we both put a lot of TLC into this one because we want to help serve the people who served us. So we feel very fortunate that we have this opportunity, this moment in time to then assess

them. And in August, we start our three-week treatment program where we have a three-week day program. They come in every day and they get this integrative model of care, the four circles that we're talking about, Daniel. And we are just very excited that we get to, for the first time, implement this kind of a care model and a group of people that we are just so excited to be able to help and serve. That is so awesome. I love that. So if you go, hey, Daniel, single most important thing you've learned from 185,000 scans, that's where we are now. I'd go mild traumatic brain injury is a major cause of psychiatric illness that nobody knows. Because most psychiatrists never look at the brain, and on SPECT or PAT, you clearly can see traumatic brain injury patterns. The American

College of Radiology actually recommends SPECT for traumatic brain injury. The new Canadian guidelines recommend it. The European guidelines recommend it. And when you see it, you're like, oh, no wonder you're depressed. And then working on rehabilitating it, which is completely possible. If you put the brain in a healing environment, you just change their lives in such an important way. Andrew, final thoughts?

Well, this has just been wonderful to be talking with all of you. And obviously, all three of us are deeply concerned about the brain health of everyone out there. And it's exciting to be part of that process and be able to work with all of you towards that end. You know, I think to me, as a brain imaging guy in particular, you know, goes back to one of your first questions about the biology of what's going on. And it does come down to what's going on in your brain and being able to see that using our brain scans and being able to understand the you know we're we're just at the beginning of trying to figure all of this out and that's part of what's so exciting and hopefully uh through

our book and the works that the work that all of us are doing uh will bring everybody along for the ride and help people to just be as healthy as they can be and recover from issues and problems that they face and uh and hopefully uh we can we can get our entire society our entire community of people uh and even around the world uh to a better place and hopefully that's the ultimate goal for all of us it's a privilege to be sitting here with the two top brain imagers in the world so So I really appreciate everything I've learned from you both. Well, thank you so much. I'm grateful to both of you.

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