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Celebrity Profiles
By Richard Laliberte

Dr. Sanjay Gupta Gives Advice on How to Improve Brain Health

CNN correspondent and neurosurgeon Sanjay Gupta advocates for better brain health through simple lifestyle changes.

Dr. Sanjay Gupta
In a new book, Keep Sharp, Dr. Sanjay Gupta explores how to optimize brain health. Courtesy CNN

Most people recognize Sanjay Gupta, MD, from CNN, the 24-hour news channel where he's been a medical correspondent for nearly 20 years. But he's also a practicing neurosurgeon, and in April 2003 he was asked to perform surgery in the midst of a story he was reporting.

It was during the Iraq War, and Dr. Gupta was embedded with a mobile medical unit just behind the front lines. A 23-year-old Marine lieutenant, Jesus Vidana, had been shot in the head by a sniper and pronounced dead in the field. He had no pulse, but he still had a faint heartbeat when he was brought to the surgical tent, where Navy doctors recognized the value of Dr. Gupta's specialized skills. “I was asked to step back from my journalist role to look at his gunshot wound,” he later reported for CNN. “Shortly thereafter, I was removing a bullet from his brain.” Vidana recovered, and the two men—bound by an event seared into both their memories—later reconnected in the United States.

Dr. Gupta, 51, has become known for such in-the-trenches reporting on wars, disasters, and epidemics. He reported from New Orleans after Hurricane Katrina in 2005, from Japan following its devastating earthquake and tsunami in 2010, from Pakistan during unprecedented flooding that same year, from Guinea during the Ebola outbreak of 2014, from Nepal after a major earthquake in 2015, and from Puerto Rico in the wake of Hurricane Maria in 2017. He's also covered a range of health-related topics, from climate change and suicide to the worldwide quest for secrets to living a longer and healthier life, and, most recently, COVID-19.

Dr. Gupta in Afghanistan in 2011
On location in Afghanistan in 2011, Dr. Gupta reported on the US involvement in the conflict. Courtesy Danielle Dellorto/CNN

Along the way, he's scooped up multiple Emmy and Peabody awards and written several books, including his latest, Keep Sharp: Build a Better Brain at Any Age (Simon & Schuster, 2021)—all while maintaining positions as associate professor of neurosurgery at Emory University and associate chief of neurosurgery at Grady Memorial Hospital in Atlanta.

Looking back, Dr. Gupta points to the remarkable recovery of that Marine in Iraq as dramatic evidence of the brain's resilience and capacity for growth. “The biggest misconception about the brain is that it's fixed from birth—that there are only so many cells, you can't foster new connections, people are doomed to be forgetful, and cognitive decline is inevitable,” he says. “It's not inevitable. The brain is malleable and changeable, and can improve throughout our lives.”

Becoming a doctor, let alone an internationally recognized one, wasn't a future Dr. Gupta envisioned while growing up near Detroit, where his parents—immigrants from India—worked as engineers at Ford Motor Company. When he was young, his interests and reading ranged widely. Then a beloved grandfather had a stroke when Sanjay was 13. While spending time at the hospital and talking to his grandfather's physicians, the teenager became fascinated with brain function. His reading turned toward medicine, and as a high school senior he was accepted into a program at the University of Michigan that allowed him to begin medical school as an undergraduate.

He also enjoyed writing. Doing stories on health subjects for small magazines and newspapers quickly led to pieces for high-profile publications. Those in turn led to a fellowship at the White House, where he helped plan events and write speeches during Bill Clinton's presidency. After Dr. Gupta received his medical degree and completed his residency, he interviewed for a position at Emory; while in Atlanta, he bumped into a CNN executive he'd met during his time in Washington. The executive invited Dr. Gupta to join the network's medical news team.

Dr. Gupta meeting with doctors in Haiti
In 2010, Dr. Gupta met with doctors in Port-au-Prince, Haiti, after its devastating earthquake. Courtesy Jonathan Torgovnik

At CNN Dr. Gupta began his disaster reporting with his coverage of the aftermath of the September 11, 2001, terrorist attacks in New York City and the anthrax incidents that followed. He also took up reporting on AIDS. That work has provided meaningful perspective on the COVID-19 pandemic, which he has covered extensively for CNN, both on television and in a podcast called Coronavirus: Fact vs. Fiction.

“Journalists are going through pandemic fatigue too,” Dr. Gupta says. “I'm used to covering wars and disasters, but as terrible as those things are, they affect local populations. With COVID-19, there's nobody in the world who is not affected.” This pervasiveness can lead to a sense of despondency, he says: “We're all feeling it.”

Acknowledging that we're in it together is one way to manage anxiety over COVID, he says. Another is to take action to protect yourself. “What's striking to me is that some of the most efficient tools for controlling the pandemic are tools we've known about for years,” he says of tactics like wearing masks and avoiding crowds. “They're the same tools we employed in [the flu pandemic of] 1918.”

Dr. Gupta recieving COVID-19 vaccine
Dr. Gupta, who has covered the COVID-19 pandemic since it started in March 2020, is shown here getting his first dose of the Pfizer vaccine. Courtesy Simon & Schuster

At the same time, fast-paced medical innovation that has produced multiple vaccines in less than a year is “mind-boggling,” Dr. Gupta says. He recommends getting a vaccine as soon as possible, particularly if you have a risk factor like age or a preexisting condition—advice he's given his own parents, who are in their late seventies. “They're considered vulnerable, so they're among those who should be first in line,” he says.

As more than one vaccine becomes available, consult your doctor about which is best for you. “Effectiveness may vary in different populations,” Dr. Gupta says. “Be candid about your medical history, including any neurodegenerative disease, and ask, ‘How effective and safe is this vaccine for me given my specific medical history?’”

Questions remain about the long-term effects of COVID-19 on people who have recovered. Viral infections, including those from measles, Zika, and previous coronaviruses, have been known to cause neurologic “after-punches” that can occur post-COVID-19 as well, Dr. Gupta says. Lingering difficulties have included brain fog, fatigue, and loss of smell or taste. “Many people with COVID-19 experience neurologic symptoms even months later, but we don't know how long they last,” Dr. Gupta says. “The longest data we have are not even a year old.” (For more about post-COVID-19 recovery, read The Long Road to COVID-19 Recovery.)

He anticipates that the worst of the pandemic will occur this winter, and then it will recede. “We'll get through this,” Dr. Gupta says. “We saw that in 1918, when two years later we had the Roaring Twenties. There's a good chance that will happen here as well.”

Dr. Gupta doing field research for his book
Dr. Gupta did fieldwork for his book Chasing Life, about research into health and longevity. Danielle Dellorto

Building Resilience

Dr. Gupta's books take a similar big-picture view of things. Both Chasing Life: New Discoveries in the Search for Immortality to Help You Age Less Today (Grand Central Life & Style, 2007) and Cheating Death: The Doctors and Medical Miracles That Are Saving Lives Against All Odds (Grand Central Life & Style, 2009) entailed wide-ranging reporting and extensive travel to investigate scientists' research into—and ordinary people's experience with—how to stay healthy and increase longevity.

His new book, Keep Sharp, is about optimizing brain health. “Most adults recognize the importance of brain health but have no idea how to achieve it or even if it's possible,” Dr. Gupta says. “I wanted to show how to do it.” As he dug through the research, he came to focus on Alzheimer's disease and other forms of dementia. That's partly because they tend to dominate people's thinking about brain health, but also because he was amazed by what he discovered.

“There's a lot of science around Alzheimer's and dementia that I hadn't fully appreciated,” Dr. Gupta says. One surprise was that Alzheimer's starts—often symptomless—in the brain decades earlier than is widely supposed; another was that it may be largely preventable. “I'm a brain surgeon, but Alzheimer's and neurodegenerative diseases are generally not surgical conditions,” he says. “In some ways, I was learning about prevention for the first time.”

Neurologists doing research welcome Dr. Gupta's help in spreading the word. “Not only does Dr. Gupta have access to the formal data in the literature, but no researcher would decline a call from him, so he's in a position to understand what's happening,” says Steven T. DeKosky, MD, FAAN, deputy director of the McKnight Brain Institute and professor of Alzheimer's research at the University of Florida College of Medicine.

Dr. Gupta identifies five main contributors to brain health that people can control: being more active, keeping the brain stimulated, getting restful sleep, nourishing the body, and having a vibrant social life. “We don't think of these measures as explicitly related to Alzheimer's but rather related to building cognitive reserve or resilience—that is, the ability of the brain to absorb some insult or injury and either fight it off or not be as impaired,” Dr. DeKosky says. Although resilience-promoting habits may not prevent a disease, “they may delay its impact or slow its emergence or progression,” Dr. DeKosky says. “When we talk about brain health, that's a big part of what we mean.”

Much of the research has pertained to dementia, but scientists expect that cognitive resilience can protect the brain and nervous system against many conditions, including other neurodegenerative diseases and traumatic brain injury. “In Parkinson's disease, for example, we know that motor exercise in patients who are taught to box against pads reinforces function, balance, and strength,” says Ronald C. Petersen, MD, PhD, FAAN, director of the Mayo Clinic Study of Aging and one of Dr. Gupta's Keep Sharp sources. “I think the general principles that Dr. Gupta recommends have applications beyond dementia and Alzheimer's even though the precise research showing transferability from one disease to another isn't there yet.”

The benefit of physical activity is one of Keep Sharp's key takeaways. “People ask, ‘What's the single most important thing for brain function and mitigating disease?’” Dr. Gupta says. “The answer is exercise. And it's as easy as walking.” He reiterates recommendations to be moderately active at least 150 minutes a week—the equivalent of half an hour on five days or 50 minutes on three days. Alternating among varying levels of speed, intensity, and effort and including strength training in your exercise provide an additional boost.

Even in people already experiencing mild cognitive impairment, “physical exercise may slow the rate of progression from mild cognitive impairment to dementia,” Dr. Petersen says. The evidence for this is strong enough that he and other members of an American Academy of Neurology subcommittee recommended getting regular exercise in a guideline update for mild cognitive impairment published in 2018.

Experts note that lifestyle factors are interrelated. Exercise and diet—which can improve brain health—lessen the likelihood of obesity, diabetes, and high blood pressure, which undermine brain health, Dr. DeKosky says. Research indicates that building resilience by controlling risk factors may be especially important in middle age, even though that may be years before any neurologic deficits begin to appear.

Watch What You Eat

On the diet front, Dr. Gupta says to minimize your intake of refined sugars, reduce portion size, and plan meals more carefully. He also suggests adding omega-3 fatty acids to your diet from natural sources such as salmon and other oily cold-water fish. “Omega-3s are among the few nutrients to cross the blood-brain barrier, and there's good evidence they lower the overall risk of dementia,” he says.

Epidemiology studies have linked higher consumption of dietary omega-3 with better brain outcomes in broad populations, says Yian Gu, MD, PhD, assistant professor of neurologic sciences at Columbia University and its Taub Institute for Research on Alzheimer's Disease and the Aging Brain. Yet clinical trials attempting to show a positive influence in people with neurologic diseases like Alzheimer's have been inconsistent. “Interventional trials on omega-3 supplements have a lot of challenges because it's difficult to follow people for the long periods of time it might take for benefits to accumulate,” Dr. Gu says. “But of all dietary components examined so far, omega-3s seem to be among the top nutrients indicated to be beneficial for the brain and cognition.”

The impact is likely strongest for people who eat healthfully well before the onset of symptoms. “It's extremely difficult to reverse disease once the pathology is already there,” Dr. Gu says.

Some research focuses on omega-3s as they relate to people with the APOE4 gene, which is found at significantly higher rates in people who develop Alzheimer's than in the general population. Studies have found that APOE4 carriers still in their thirties—that is, decades before they experience cognitive decline—extract more omega-3s from the blood than do noncarriers, suggesting they're compensating for deficiency. As they age, these carriers develop defects in their ability to transport omega-3s into the brain. Researchers are looking into whether high-dose omega-3 supplements might help those with APOE4 keep adequate levels of the nutrient in their brains, says Dr. Gu.

For now, Dr. Gu agrees with Dr. Gupta that the best way to get omega-3s is through food. “Eating at least one serving of oily fish per week is a reasonable recommendation,” Dr. Gu says. “But omega-3s are also in foods like flaxseed, chia seeds, and walnuts.”

Dr. Gupta also emphasizes the importance of enjoying life. Socializing seems to enhance brain health, he says. “What do we know about communities that have the best brain health in the world?” he asks. “They tend to be active, have rich social connections, and don't hang on to their anxieties. Even communities that have failing grades on classic measures of health like cholesterol and smoking seem to be buffered in terms of brain health because of social connections.”

Given that information, Dr. Gupta recommends an activity that's safe during the pandemic: “Taking brisk walks with a friend and talking about your problems is a reliable way to keep your brain healthy, both immediately and in the long run.”

“I wish we knew chemically why socializing works,” Dr. DeKosky says. “We don't. But we certainly know that it does work.” The mechanism probably has something to do with an increase in hormones such as oxytocin that are triggered by social bonding, a decrease in hormones related to stress, and intellectual stimulation. “When you're playing cards with friends, you're happy, laughing, and working your brain trying to have a winning hand,” Dr. DeKosky says. “All those things appear to be associated with better brain outcomes.”

A sense of fun may enhance cognitive stimulation, the second (after exercise) of Dr. Gupta's pillars of brain health—a ranking Dr. Petersen supports. “I emphasize engaging in activities you enjoy,” Dr. Petersen says. “If it's fun, it will keep stimulating you.”

Living well also includes getting adequate sleep, which not only helps consolidate long-term memories but also aids the brain in purging built-up waste proteins produced during brain cell metabolism—a process Dr. Gupta likens to running a rinse cycle or emptying the garbage. Among these proteins is beta-amyloid, which can form plaques associated with Alzheimer's disease. Dr. Gupta writes in Keep Sharp that “failure to remove this brain trash may be linked to a higher risk of developing dementia.”

Cover of Dr. Gupta's book, Keep Sharp

While most neurologists remind their patients to maintain habits that enhance brain health, some are more cautious about the evidence. “I encourage my patients to exercise, stay cognitively and socially engaged, and eat a heart-healthy diet because these steps are very unlikely to cause harm and may promote general and even brain health,” says John Morris, MD, FAAN, professor of neurology at Washington University in St. Louis. “However, I also tell my patients that there is very little evidence that these steps promote brain health.” Citing a 2020 editorial in Neurology, Dr. Morris notes that it may be the other way around: It may be that people stop exercising because of preclinical Alzheimer's disease rather than that stopping exercise causes preclinical and later symptomatic disease.

“I appreciate the spectrum of opinions and agree with not overpromising any outcomes,” says Richard Isaacson, MD, FAAN, director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian. But he points to a 2020 Lancet Commission statement reporting that modifying 12 risk factors may prevent or delay 40 percent of cases as well as several long-term studies looking at lifestyle modifications and Alzheimer's disease as evidence that adopting healthy habits may make a difference. That's why he continues to counsel patients about what they can do to reduce their risk of cognitive decline.

Dr. Gupta is upbeat about our increasing knowledge of brain science and its implications for people's health. “We're making tremendous progress in understanding why people develop neurodegenerative diseases like Alzheimer's or other forms of dementia,” he says. “We used to think it was a fixed problem that couldn't be altered and was preordained, so if your parents had it, you would too. That's not the case, and it's inspiring to know that relatively small lifestyle changes can make a huge difference.”


Award-Winning Surgeon

The American Brain Foundation will honor Dr. Sanjay Gupta with its 2021 Public Leadership in Neurology Award at the virtual Commitment to Cures gala on April 21 in recognition of his role in raising awareness of brain health. As a neurosurgeon, neuroscientist, medical correspondent for CNN, and author, Dr. Gupta has educated the public about the brain and shed light on the realities of living with neurologic diseases. Former honorees include Michael J. Fox, Dame Julie Andrews, Walter Mondale, Ann Romney, and Emilia Clarke. For tickets to the gala, visit AmericanBrainFoundation.org.