Less Panic, More Practice: Building Brain-Healthy Routines

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katie Peters, and this is the Brain & Life podcast.

Dr. Correa:
Welcome back to the Brain and Life podcast, and whether or not you kept track of it, hope you had a happy World Health Day. There's a day to celebrate attention to health in many of its ways for all of our communities. And we thought it would be a good opportunity for us to go through some of the recent articles that have been highlighted and published on brainandlife.com.
So I was taking a look, and one of the things we thought that might help us organize what we want to talk about was actually a great question we got from a listener. So this question comes in from Kellen in Nevada who wrote, "I like listening to health podcasts and following blogs and stuff, but I also feel like I come away from it even more stressed sometimes. Is there some kind of list of small, little actions that I can do to create small but meaningful changes for my brain health?" Thank you so much, Kellen. I think that's a perfect question to lead us off.

Dr. Peters:
Yeah. Happy World Health Day, Kellen, or two days after. Happy World Health Day to you, Daniel. And I agree, that's a great question from Kellen and we should tap into how we like to engage ourselves with tasks. And everybody's different. You do tasks in a certain way, in a certain rhythm, and how you achieve goals. Personally, I'm a big fan of planners and lists and daily tasks, so that works for me to have something to check off. And so if you think about small chunks, it can feel like it's more doable. So you can think about small chunks of maybe increase exercise, but maybe just do it for certain increments or plan. Like when I was doing some of my Pilates sessions, which I really enjoyed, or improving your sleep hygiene or eating more brain forward meals. Those include leafy greens, berries, nuts, olive oil, fish.
But I like the idea of consistency because if I have lists and schedules, it sort of helps me with that. And so maybe you can just pick two or three items a day and do those every day. And then you can add one more once those good habits stick, because they are habits and it needs to become your everyday routine, just like brushing your teeth or washing your face. Currently for me, my big check things are, I like to read at night before bed and be very mindful about that. And then also a very fiber packed breakfast in the morning. And then I'm almost always, except I didn't do it today, have a leafy green salad for lunch. And if I just do those things, know that that's going to happen every day for those two to three things and keep that checked off and then add something else on as you go along.
I think it can be really helpful.

Dr. Correa:
Yeah, exactly. And we have to find how these things fit into our lives because it's about finding the way that we can do them consistently and integrate them. And it can't just be like a set of tasks to check boxes no matter what, because that's not really like responding to how our days actually go or learning how our bodies respond to these different interventions or changes and habits that we might try to take on. And so like the goal is not necessarily adding more things for you to do. It's helping you adapt your activities in the day in ways that you see make a clear benefit for you, both in the short term and that you know then from the evidence that's out there that make bigger changes for you in the long term, brain health should not come as one more thing that makes you anxious.
For most people, the answer shouldn't necessarily be do everything. And we may often talk about lots of things you could do, but I like your point of picking two maybe. One that feels very approachable and that might be the biggest change for you in your life and one that maybe feels a little hard and you just want to try out. And so see how they feel and these things you read about sound to you. If a thing that you're focused on is working on a diet item or your sleep, your environment, a meditation or mindfulness practice, pick a few small things that you can actually work towards repeating. And I like the, something I've heard from run coaching environments is you can't necessarily do every day and every workout per se as an A+. It's impossible to always get perfect. It's much more about consistently getting maybe some B minus days.
And the more often you're doing that consistently, the bigger impact rather than having one day a week that you somehow do all of the 10 things that are out there about what you can do because then if you're not somehow learning the rest of the week to integrate improving your sleep and increasing fiber in your diet and some of the other things that you really find that you can do, then it's just one single heroic effort.

Dr. Peters:
Yeah. And I think one thing is, we're sometimes in different environments. We may be traveling or we may be like in a different setting. Sometimes people are like at their home office, but maybe in an office office. So I think also if you can find ways to do simple, small sets of things that are meaningful habits that easily fit in those myriad of different environments, I think they can really be beneficial. So one of the things that really helps with me is also having like sort of a fun ... I have a fun salad box that I love. It's my Bento Box. But I really like that one thing and I have this little bag I carry it in. And so I know that I pack that every day and wherever I am, it would sort of be whether it's my home refrigerator or my refrigerator at work.
And even the people I know that it's my thing. So again, simple set of small, meaningful habits, maybe making them fun and easy, making them accessible for all environments. And it just makes you, I guess, a little more calm and makes it just a little easier.

Dr. Correa:
Yes. I like that. A less panic and more practical list. So we've worked towards framing this segment as not some big giant makeover of your time and day, but to look at some of the articles that bring up things that we can all consider incorporating into part of our day, our week, maybe the next month, and think of which of the one or two things that really seem to resonate for you as a place to start.

Dr. Peters:
I like that less panic, more practice. I think that sounds really good.

Dr. Correa:
So my first small action item that I thought that ties back to one of the articles would be protecting your sleep. And the both of us, many of us travel for lots of different reasons. And it's not about perfect sleep, not just about one great night, but we're working towards better sleep habits. I am at fault of having sometimes poor sleep habits, either because of work or because of the phone access, all kinds of things. And along these lines, we're looking at a recent Brain and Life article on recovering from jet lag. One of the big themes is that your brain really pays attention to the light, the timing of the day, and your routine. So something as basic as getting morning light, keeping your wake time fairly consistent, and then adjusting your bedtime gradually before you travel can help make it a better transition for you and might impact you and how well and how you feel during your travel, vacation, or work otherwise, and when you come back home more than you really realize.
And if sleep is chronically off, then that's worth bringing that up with your doctor to look at other ways that you can work on it. This article that you can find online is neurologists share tips on recovering from jet lag.

Dr. Peters:
And I remember when I used to travel, Daniel, when I first sort of started out doing some international talks and traveling for work, I just sort of winged it and just sort of didn't really hold onto the science. But I will say if you do really learn how to think about the light and the timing and like caffeine intake, it can really be helpful. So I'm going to give a shout-out to my colleague who's also a neurologist and a neuro oncologist, Dr. Yoshi Yamura, she told me about this app called Timeshifter and essentially it helps you develop a plan based on your travel schedule about what your sleep/wake cycle should be and like when should you get light, when should you drink caffeine? When should you be in the dark or wear dark glasses and even about sort of how to use melatonin appropriately.
Again, you should always talk to your doctor before you do anything or take any medications, but I actually really liked it because when I traveled to Asia last year, it was really helpful. And to Australia, it really was a game changer for me. And I even started in clinic and I'd wear my dart glasses around. It was a little hard when you're trying to read MRIs, but I made it work. But I think it just also taught me about sort of how to do that task. And I really thought it was nice because I felt much more prepared when I was traveling across time zones and it made it so that each 30 minutes was sort of divided into a chunk of time. And my husband didn't do it, but I did it and he had much more jet lag than I did. So I was like, I guess we were like an experiment because we both went on the trip together to the same place.
And so it really did help. But I feel like now that I've sort of learned those skills, because that's all I think you really need to do is learn how to do that. I think now I'm a little bit of a better traveler and just more mindful to it.

Dr. Correa:
Yeah. I mean, I think that's great. The small cues with a meaningful effect like that. I mean, for me, one thing that I've learned, as soon as I arrive to where I'm going, I need to kind of try to have a sense of the actual time and the light that's there. So even if it's later in the night or early, I try to just, even if I can get outside, outside of the stress of the travel and carrying the bags and getting to the hotel room, like once that's all set, go outside briefly. And even if it's a short walk at night or otherwise, and that feel like I get more of a sense of the time of where I'm at and then set an alarm usually for the next morning and get up early around that time of sunrise or before I have whatever meeting that we're doing.
And even if it's just a five minute walk and be outside and get the light or see that change in time is such a help in making the transition of those days. When we have the privilege and the opportunity to do those kinds of things.

Dr. Peters:
I agree. And when we travel for work, it can really get your schedule off, but back to sort of that little habits, one of the things that if I do travel, I guess in the United States and I don't have to go to a meeting right away, what I like to do is the first thing when I get to the hotel or wherever I'm going is try to get some exercise in. And so I actually will wear exercise clothes, so I force myself to go straight to the gym, but it's just another one of those little habits. But another thing that's happening that's, I guess on sort of a timely note about time and jet lag and time zones is that we had our sort of own enforced time zone change because we had our spring forward daylight savings time. And I'll tell you what, I don't know what, it was hard this year for me. I still feel a little behind. How did you feel with the time change?

Dr. Correa:
Yeah. I mean, it is always a transition for me, but over the years, more recently, I've learned, I get up, thankfully our phones automatically change for us now. So I just follow my regular alarm routine, get up and even if it's a day where I'm not normally going to do exercise, I try to just get up and do ... Like when we travel, a 5 or 10 minute walk or small jog and be outside, if it's really bad weather with a coat and I'll just walk my dog. But that sense and having a clear sense of the time has helped me adjust a lot. But I usually end up needing a nap in the afternoon after those initial days. And it's not just in your head. Various research studies have described potentially deleterious impacts of daylight savings time on our brain, overall health and various medical conditions, and many physicians and organizations have called for really some reconsideration of whether or not we should be doing daylight saving time.
And in fact, new research suggests that for people with migraine, that daylight savings shift or the saving time shift can mean less deep sleep, more migraine days. And so this is a good moment to go easy on yourself, even though we are still several weeks past that, we're in that transition and finding our routine for those times along with all the other weather changes. So getting light in the morning and a little more intentional thought about your sleep and planning in those first weeks or where we are now can be very important. And we've seen other studies describing disruption in that sleep cycle, increased sleepiness, disruptions actually in some of the vascular changes or the blood vessel changes that occur in the body and brain, putting people at greater risk for stroke and heart attacks. So as we said, it's a good time to be taking care of yourself and being kind to yourself.
So for our second one, I thought we would get to thinking about food. What do you think, Katie?

Dr. Peters:
I feel like you always love the food ones.

Dr. Correa:
Yes, I do.

Dr. Peters:
And he lives in New York and it's all about the wonderful food and being a foodie there. It doesn't be fun.

Dr. Correa:
Yeah. I think my wife would definitely say I have a very strong gut-brain connection.

Dr. Peters:
I know. But to feed your brain, you also need to tend to your gut or feed your gut and you need to do that a little bit better. And the gut, there was a gut brain article as sort of a good reminder. It was called The Gut Brain Connection, Why a Healthy Microbiome is Key to disease prevention. And this is really about sort of how important our microbiome is in our GI Tract. And it doesn't start with like just going straight and getting those prebiotics or probiotics that are sometimes also very expensive. I like that it's really about, and I always tell my patients this, it's about adding on those natural foods and a very practical first step is to add on one fiber-rich plant food that you weren't getting before. Oats are a great example. Overnight oats, I'm a big fan of that. Beans, berries, it's almost going to be strawberry picking seasons, you can get out there, apples, nuts, really good leafy vegetables, really whatever is sort of that you like and like to integrate.
And you'd be surprised how you can start integrating and how those can also become part of your habits. And also think about the nice seeds that you can also have in addition to nuts. It also points out about fermented foods, which I think are sort of becoming all the rage, whether you're drinking kombucha or you're having some kimchi or you just love sauerkraut or more of a Mediterranean style pattern. I actually just picked up a cookbook myself about some Mediterranean style cooking that's more vegetable based, which I'm really excited about all the recipes, but you want to sort of eat the rainbow and have a variety to really keep that microbiome happy.

Dr. Correa:
Yeah. And I like that you laid it out and the article goes into just the much more practical steps. And before buying lots of different things in the shopping aisle, take a look at what other things we're actually eating and to see how many changes we can make there. That phrase gut microbiome can make some people feel like they need a PhD or go sit in a class to understand all this. And there's people who specialize in those things, but then they write these articles to break it down for us. And you don't need necessarily a shopping cart full of powders and pills. And so I think it's taking a look and first, where can we add some more of these fiber rich and fermented foods? And sometimes those things might actually be easier for our digestion to slowly add in and make adaptations than adding five new gel capsules and pills every morning.

Dr. Peters:
I just made some wonderful brand muffins. They were really good. So just adding a little more fiber, adding another plant, you don't have to have like a really dramatic overhaul all at once. Just start adding things once by one. And my muffins were really good.

Dr. Correa:
So for our third point, moving on with our bodies in a way that feels sustainable and not punishing, and as we talked about, not a heroic all or nothing effort, this microbiome article also touched on physical activity. And more broadly, we know movement supports sleep, our mood, our vascular health, and our overall brain health. And so this could be a 10-minute walk, maybe just when you're feeling a little sore and stiff in the morning, some stretching while you listen to music. And when you can, choosing to take the stairs. A lot of places sometimes have that suggestion to take the stairs at least one or two flights up and one or two flights down and limit use of elevators or otherwise if we're otherwise able to do that or just with your family, kids or a cat dancing in your kitchen. So all these kinds of movements that get your heart rate going up a little bit.
And eventually you want to work towards where your heart rate's going at a point where it's a little bit of a challenge to keep your breath, but ease yourself into there several days a week.

Dr. Peters:
So it's the [foreign language 00:19:52]. Do you know what that means?

Dr. Correa:
No.

Dr. Peters:
Taking a walk in Italian. It's the evening stroll after dinner. I like that. My husband has now become a big fan of this, is to walk around to do this. So exercise doesn't have to be like going straight to bootcamp or going to Pilates or hot yoga. Just getting out there and having a little walk, like a nice little stroll after dinner, that's what that [foreign language 00:20:20] is. So it can really help your gut and help also help move and digest the food. I mean, we want our food to become digestible, so activity can actually help with that.

Dr. Correa:
Yeah. And it is good to continually try to challenge yourself a little bit more. So as you get that walk in the evening after dinner, or as you get some of these other activities going, then trying a little something new. Not only that helps with how we adapt to things and balance and other aspects, but that's where then keeping a little bit of the exercise with some of a challenge helps improve and move us forward.

Dr. Peters:
So I think we should really move on to sort of what is the next steps of other articles that we looked at. And there was something that we always like to talk about on the podcast and a common topic is caregivers because it is just so important. We have so many amazing caregiver related stories on the podcast. And there is one article that is highlighting this month about how to really take care of yourself if you're in that caregiver role, and what are sort of some important things that caregivers can do to really care for themselves?

Dr. Correa:
Yeah. I mean, I'm glad you bring that up. I hope we all have the opportunity and the privilege to be there for someone close to us. And that article really makes the point that caregiver self-care is not selfish. It's protective so that you can both be there for that individual and that person that's close to you or that you love, along with also maintaining and improving and supporting your own health. When people are stretched too far, we see it both in physicians and healthcare providers, but also in caregivers, burnout can show up physically, emotionally, and cognitively. Some other small actions along in that is asking one specific thing or kind of help that someone can step in and help you with. Not, I'm overwhelmed, although that is real too, but more like, "Can you stay with mom for two hours on Thursday?" And maybe even informing and say, "So that I can..." and fill out, or, "Can you pick up groceries for us? Can you make this phone call to X," healthcare provider, the bank, all these other stressful things that we have to juggle.
The related brain and life caregiver resources also emphasize support groups, boundaries, and planned respite or breaks and rest because waiting until you are totally depleted is not a great strategy. And we tell this to our fellow healthcare providers, but I think sometimes we all end up needing to hear this. When we feel that someone that we love or close to us truly needs us and we maybe don't necessarily see who is going to be the one to step in, until we ask for help, we can really, truly deplete ourselves sometimes to empty.

Dr. Peters:
And I see this every day with my wonderful patients and their wonderful caregivers. There are good days, but there can be very, very, very tough days. You need to lean into self-care every day and be willing to accept and seek support. So many caregivers just do amazing job of caring for their loved ones, but they're much less comfortable sometimes admitting that they need backup. And so I think you need us as providers, I think one of our goals is to engage those caregivers to help them find resources. This is why I think Brain and Life is so great is when we can give articles, just like this article, why taking care of yourself is one of the most important things that caregivers can do in the online magazine is just so important. So I will send my caregivers to look at these articles so they can have those resources and caregiving works best when it's shared and sustainable.
And the only way to sustain it is to protect yourself with really self-care that is consistent. It doesn't have to be huge. It just needs to be sort of carved out time. And some tips that I like from the article is make your own health a priority, including sleep, exercise, medical care, ask for help early and build a support network, just so key. Take some breaks, even if they're short ones. I think that's really important. And I just had a conversation with a patient yesterday about staying socially connected and maintaining a life outside of caregiving. That is really key. And sometimes when you're so focused on the loved one's health issues or challenges, that focus, you sort of lose the focus of interacting with people that you normally interact with. This is a hard one for me, letting go of the guilt of needing support.
That's tough, but you've got to try to say, people do want to help and surround you. So definitely try to let that go if you can. And again, I just want to say, I'm so thankful for all the caregivers and I just appreciate them so much and for all that they do for our patients. But I think this is a really a good time to check out this article. I think it's really good. I think everybody can benefit from looking at this because they've all been in this situation where they've had to care for a loved one.

Dr. Correa:
Yes. Yes, absolutely. And sometimes the bravest thing is not necessarily just pushing through. It's letting someone else in. That is a kindness often to those that are around you. There are often so many people that are also hurting along with you, want to find a way to help and support both you and those that you're supporting. And so finding a way to even just say and ask for help or say specific things that you need can be a kindness to others.

Dr. Peters:
So we've actually have a pretty good list here. So far, we're protecting our sleep. One, two, we're adding some plants and some permitted foods for our gut. Next is we're moving around, we're moving and grooving, getting a little exercise and for our caregivers asking for help. So Daniel, what's number five?

Dr. Correa:
So I mean, one of the ones that we hear about all the time is like, how do we use technology and maybe some of the ways it interrupts things. And so using technology as a tool and not necessarily as a judgment of our activity or where we are with our health is something I think we can all work towards. And one of the articles highlighted looking at everyday wearables, particularly in multiple sclerosis, but we can, I think, incorporate and think about this, how this fits with everyone. And what's interesting is not everybody needs a gadget necessarily, whether that's a Apple Watch or some other type of sleep wearable or something like that in the house. It's that the changes in day-to-day activity patterns may help flag meaningful clinical changes or life changes for you earlier, including the risk of worsening a disability or the risk of brain volume loss within multiple sclerosis.
And what's exciting is that because it suggests that the things people already wear might help be eventually helpful for patients and their physicians or clinicians to spot trends sooner. The average listener might be able to take away that simply considering learning from a wearable that you use to notice patterns, not scolding yourself when you didn't get to sleep and you have a sleep score on some device that doesn't look great. Okay. It's much more about being, "Okay, what can I adapt or change to go back to what we said before, to protect my sleep as I move forward?" If I'm not aware with the activity or the movement numbers that these devices recommend, that's fine. That's now an observation and gives you an opportunity to reflect on how your days, your week, and so have been going and the ways that you can take that moment, "All right, how can I adapt or change one or two of those things today?" This article, Everyday Wearables May Offer New Insights into Multiple Sclerosis Progression is on the online magazine for brainandlife.org.

Dr. Peters:
I was thinking about this article sort of in the context of like, we have clinical trials and then we have real life articles, sort of real life, like what happens clinically. And so the way I like to think of it is instead of sort of thinking about your clinical visit, if you were going in for MS, you're being evaluated, it's sort of about like what's happening in real life and how you can use those tools to capture real life activity patterns and detect maybe even something subtle that could change early So it gives patients and clinicians a clearer, more continuous picture of disease progression. And you could use wearable technology to open the door to have even earlier insights and more personalized care and to help those patients with MS understand the changes in their health through the rhythms of everyday living and what's happening with them day to day.

Dr. Correa:
Yeah, I mean, exactly. And I think maybe a tracker could help you notice or cue a reflection and realize that you feel better when you get a short walk in, maybe after dinner, or that fatigue is creeping up and you should bring that up next time in one of your appointments or reflect on some of the things that might be contributing it. And if you can't work some of these things out with slight adaptations and reflections based off of the information that you do have, that's a great time then to involve and discuss this further with your physician. I think that's your suggestion of this, using this as a cue to reflect, it can be very helpful and not obsessing over every number. I think that's always the concern with some of these technologies is that like Kellen brought up, there's certain things that make just all this extra data and information might cause more stress for someone.
And we don't want that. If a wearable or information from your phone or otherwise is triggering that, then maybe it's too much information. And so picking the thing that you want to work on and then you might take a look at ways that technology or otherwise could inform you about that.

Dr. Peters:
So I think we can circle back really to the question of Kellen's. And I guess our sort of big answer comes in, I guess, small packages, but brain health doesn't have to be this big, giant, stressful thing that you have to confront or project. It can be a series or a menu of tiny actions or activities.

Dr. Correa:
Yeah, I like that. And honestly, I say, pick one this week. And if it's not one of these, there are other things about considering and taking a look at your purpose or having a purpose in each day or mindful activities. So if something else, and we have articles on some of these at brainandlife.com or online, you may find other sources, but take a look and see. And if there's one that really resonates to you, pick one, just one. And because when people try to overhaul everything all at once and make these big herboic efforts, you usually end up feeling like they've failed or they start scolding themselves for this. And so start with the thing that might be a small repeatable habit. And that's then where the momentum can build and you can add. And then that thing stops feeling like it's task and now it's just part of your pattern most of the days.
Again, not even working towards a future where it's all A's. Most of the time with maybe some vacation and breaks for these activities can be good.

Dr. Peters:
So let's make a little starter list for Kellen. Okay? Okay. You ready?

Dr. Correa:
Yeah.

Dr. Peters:
One, get some morning light and protect your sleep routine.

Dr. Correa:
Yes. And so two, add a fiber rich or plant-based food to your day. So expanding those probiotic and that gut microbiome rich foods.

Dr. Peters:
And three, take that short walk or [foreign language 00:33:40], as I mentioned, and two, some movement that you can actually repeat daily.

Dr. Correa:
And four, if you're a caregiver, but many of us, even if not in the traditional sense, often have a role or opportunity to help the care and support someone. So schedule one tiny act of care for yourself or ask for one specific kind help from someone to give yourself a break even just to reflect.

Dr. Peters:
And finally, five, let some healthcare tools, you can integrate them through wearables or other technologies, but don't let them sort of like overtake your life. See if they can help you notice patterns.

Dr. Correa:
I think that's a great list.

Dr. Peters:
And also Kellen, I just want to say it's okay to take breaks from health content too. Learning about healthcare should leave you more supported, not more overwhelmed.

Dr. Correa:
Absolutely. And sometimes brain health means protecting your mental space and so you don't have to worry and turn every podcast episode into homework.

Dr. Peters:
That may be the healthiest takeaway of all.

Dr. Correa:
Well, thank you all for joining us. And please check out these articles on brainandlife.org and many of the other information. And hopefully you find it helpful. We look forward to hearing more of your questions and hearing your feedback. And stay tuned next week for another great episode.
Thank you again for joining us today on the Brain and Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life Magazine for free at brainandlife.org.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainenlife.org and leave us a message at 612-928-6206.

Dr. Correa:
You can also find that information in our show notes and you can follow Katie and me and the Brain and Life Magazine on many of your preferred social media channels. We're your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeurodoctorCorrea.

Dr. Peters:
And Dr. Katie Peters joining you from Durham, North Carolina and online @KatiePetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain and Life Podcast. See you next week.

Less Panic, More Practice: Building Brain-Healthy Routines

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