#110 Beating Brain Fog with Dr Sabina Brennan PhD

Dr Sabina Brennan: I just think we should be taught in school how our brain works.

Dr Rupy: Oh 100%. Yeah, 100%.

Dr Sabina Brennan: Yeah, exactly. You know, we're trying to figure out who we are, what's going on in the world. You know, if you just knew how this worked, life is much easier.

Dr Rupy: Things would make sense. Yeah.

Dr Sabina Brennan: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life.

Dr Rupy: Brain fog is one of the common symptoms that we see as GPs in primary care, yet the least understood, I believe. And on today's podcast, I speak with Dr Sabina Brennan PhD about her incredible career from soaps to science as she describes it and everything to do with brain fog. Dr Sabina is a chartered health psychologist, neuroscientist and host of the Super Brain podcast and bestselling author and her new book, Beating Brain Fog, takes your symptoms seriously and shows that you don't have to live with them. And on today's pod, you'll learn about why teenage brains explain their lack of inhibition, i.e the development of the teenage brain, loneliness and its relationship to poor cognition, what brain fog actually is and how it can occur as a result of hormone fluctuations, estrogen and pregnancy. And also the relationship between inflammation and viral infections, plus the concept of neuroplasticity and the difference between brain and cognitive reserve. We talk about so much more and I think you're going to love this podcast because Sabina is a fantastic communicator for science and her mission is to get everyone looking after their brain health as routinely as they brush their teeth. All the links are on the doctorskitchen.com. Do sign up and subscribe to the podcast if you enjoy it or follow along on Spotify. It really does help with the ratings and allows me to do more podcasts like this. And if you're not a subscriber to the Doctor's Kitchen newsletter, every week I suggest something to eat, watch or listen and actually for the next five weeks we're doing a special mindful cocktail addition as well where I also suggest something to drink, which is low or no alcohol. I think you're really going to love it and you can sign up at the doctorskitchen.com. On to the podcast. Tell me about your your TV career. We were just talking about that at the start of this. So I I didn't I didn't realise that you you were doing TV before.

Dr Sabina Brennan: Yeah. Yeah, yeah. I left soap for science.

Dr Rupy: Soap for science. That should be on a t-shirt.

Dr Sabina Brennan: Well, actually, I I stole it from a journalist who at the time when they discovered. Yeah, I was an actor. We have a soap opera here in Ireland. I'm based in Ireland, so it goes out five nights a week. It's called Fair City. And um, yeah, I was in like 160 episodes. Yeah, I played. I was a really lovely. Obviously I was an actor. I was going to say. I was an actor back then. Um, and um, yeah, it was a it was a really, really, really cool part because it's a good it's a long time ago now, but um, yeah, I played a victim of domestic violence. So, um, uh, and she had kids and blah, blah, blah. And then I suppose it advances the story then ultimately, uh, she stupidly, um, it was a great storyline actually because it was back, when was it? I left the show in like 2003. So, um, it was the first time certainly on our TV that, you know, that topic was really covered and they, you know, had to open helplines after the show. Like it was kind of one of those. But also it, you know, addressed another issue which back in Ireland was, um, you know, quite kind of groundbreaking back then as well. So she had taken him back and she had, she had three kids and then she took him back. He he found her again and she kind of took him back. He said he was changed and all the rest. And um, sorry, I'm smiling here because I remember a woman, I remember being in M&S shopping and a woman saying, don't take him back. Don't take him back. It's funny the memories that just pop in.

Dr Rupy: But it's so visceral when you watch it because I used to be a big fan of like East Enders when I was growing up and you really, you you just see that person as that person that they're playing. You don't think about anything else. You don't think about them as an actor.

Dr Sabina Brennan: Yeah, well, I think what it is, George Clooney, not putting myself in the same category as George Clooney, but he he once said because obviously he started from soap. Um, so basically he said, when you're a soap actor, you are in someone's living room every night of the week while they're having their dinner or whatever. When you're a movie star, well, this was kind of before Netflix and all that sort of thing. You know, people have to go out and they're seeing you on the big screen and so there's this huge distance between you. But when you're a soap star, you're in their house. You know, and and um, yeah, it's kind it's interesting, but I I think it's a great medium for exploring issues, you know, big issues like like like that issue. But the thing that she did then was she became pregnant again and she didn't want to expose another child to the abuse in case it happened again. So actually she went and had a procedure and that's what happened. He the doctor rang to say something and he took the call. So ultimately anyway, I was strangled to death live on TV.

Dr Rupy: Oh wow. Oh my god. Because that's another subject as well in Ireland. That's like another huge subject.

Dr Sabina Brennan: Yeah, yeah, yeah, yeah, it was, it was, it was good at the time. But anyway, it left me unemployed. And so but prior prior to that, had you been interested in in science? Is that something that you you liked at school or?

Dr Sabina Brennan: Yeah, well, prior to being an actor, that wasn't my first career. That was my second career. Um, prior to being, I left school at 16 and uh, no, I had done my leaving cert, which is, you know, a bit like your A levels. So, um, and I had also done O levels, which was unusual here. But um, I know I worked in the life insurance company because that's where my dad worked and he wanted, he wanted one of his kids to work there. That was the height of his ambition, you know, and uh, none of the other four got in. So I said, oh mom, I'll do it. So I worked in a really boring job for 15 years. Oh, anyway, anyway, anyway. Um, uh, yes, I did and actually it relates to my dad. Uh, as a kid, I just loved, my dad loved to read and he had big kind of big books, you know, like they weren't encyclopedias but but like that. And for younger people, encyclopedias were like the Google but in hardback. You bought volumes of them.

Dr Rupy: I love how we have to explain that to the new kids now, don't we?

Dr Sabina Brennan: Well, it kind of is, you know. Um, anyway, um, yeah, so I remember this particular book my dad had and it was like, I don't even know what it was called, but I used to a treat for me was to take it and then after he'd got up and my mom had got up, get into their room and in bed, the sun used to come into their room in the morning and go through the book and I remember there was like, what's this? Was it Mendelson? I can't say it. He did the genetics with the peas, you know.

Dr Rupy: Oh, Mendelian.

Dr Sabina Brennan: Mendelian, yes, thank you. And um, you know, it had uh, you know, evolution and uh, it just had all that stuff and it had images and pictures and obviously there and I just loved it. I found it fascinating. So actually the funny thing is really, one of the reasons, um, I should tell your listeners, so then after I finished on that show, then, um, uh, I kind of Ireland is a little bit different. I knew I'd become unemployable for a while because it was such a high profile story and there's not that much television was being made in Ireland back then and also there's always much less parts for women. It's changed a lot now, but back then, um, there really wasn't. So, um, I thought that I might do a night course and my eldest son also had been diagnosed with a learning disability and um, dyslexia as an umbrella term, you know. And I was kind of trying to educate myself on that because I felt that uh, the school was failing him and it didn't, he didn't really just fit into that diagnosis properly, you know, he, um, he had a reading age beyond his own reading age. His issue was with written language, you know. Anyway, um, yeah, that's a long way of saying I thought I'd do a night course and when I rang the university to inquire about the night course, they said, um, oh, would you consider doing, you know, it was a psychology course. Would you consider doing, um, like our applications for mature students, um, you'd be eligible, you know. And I said, oh, okay, Grant, when and she said, well, the application closes at 5 o'clock today. This is about 20 past four. Anyway, long story short, I did interviews, exams and I just found myself doing a full-time degree in psychology. And I thought I would combine it with acting. Uh, but I just loved it. I just ate up the books and a lot of people said to me, going from acting to psychology, like that's a big jump. And I went, no, it's not. That's why I was an actor. Like I I trained as a theater actor from the age of eight and did all my exams and qualified as a drama teacher, but I wasn't really interested in theater because I wasn't interested in performing every night. I wanted to figure out what's going on inside that person's head and why would they behave that way? And when they're saying that, what are they really saying inside their head? So, yeah, I was one of those students that young students absolutely hate and actually some of the lecturers told me afterwards, we used to be terrified when you put your hand up for a question. Because I'd have read, like I read all the books before. I couldn't understand why we had to stop for summertime. I could get my degree finished quicker, you know. But I'll say to any of your listeners that actually are older. So I was 42 when I went to university. So, uh, I'd say to any of your listeners who are, you know, terrified or put off because I was. Like I was afraid. Um, you know, because I left school at 16. I hadn't studied anything and I'd always felt that people who've been to university, they have some knowledge that the rest of us don't have. And I kind of realised, no, they don't really.

Dr Rupy: No, definitely not.

Dr Sabina Brennan: And actually, you know, life experience, handling mortgages, raising kids, all those sort of things are much harder than doing an undergrad degree. PhD is different. So, um, I did my undergrad in three years and then I got a I got a scholarship going into my third year from the the the government of Ireland here to do um, a PhD in Trinity. Um, and yeah, so then I did a PhD, uh, neurocognitive and electrophysiological indices of cognitive uh, performance in aging. There you go.

Dr Rupy: Wow, that's a mouthful.

Dr Sabina Brennan: Oh god, yeah, yeah. The PhD was less fun. Yeah, do you do, yeah, electrophysiology. So for listeners, it's like, um, you know, if you go and get your heart measured and they put stickers on it and it's they're measuring the electrical activity in your heart. I was measuring electrical activity in people's brains. So you I'm sure you've seen it at these caps and they have 64 electrodes and basically I measured that when they were doing certain um, memory tests or attention tests and then I also did full neuropsychological profiling on them and essentially just trying to identify, you know, where people were performing outside the normal range in terms of memory function, could we see any patterns? I don't ask me the answers, it's in my PhD. Go read it.

Dr Rupy: Yeah, yeah, no, of course, yeah, yeah. Well, it's interesting that because in your book, you do have a section which is dedicated to the different areas of the brain which are responsible for different processing, you know, executive function, learning, all that kind of stuff. Um, so obviously that PhD has kind of come through and and the other thing I was going to say on on the note of um, uh, university and and undergraduates versus mature students is and I don't like that term mature students. It seems to suggest something else.

Dr Sabina Brennan: Yeah, you can be as old as hell and completely immature. Yeah, exactly. You can go in your 80s and 90s, you can be mature.

Dr Rupy: But um, I think had I gone to med school as uh, as my age now, I'm 35, I probably would have been a lot more attentive, a lot more sort of engaged in the learning process rather than, you know, kind of enjoying my youth at the same time. Like I think I would have gleaned a lot more from the actual course.

Dr Sabina Brennan: Something something I I actually feel really, really strongly about. I think education is wasted. It's it's the wrong time. So I feel about this, society has just set itself up for convenience, you know, it starts kind of with the industrial revolution about, you know, working nine to five and you know, those kind of things and eating three times a day, you know, and and uh, all those kind of things are set up to facilitate the way a society thinks that it's good to work. Now, a lot of that stuff was set up before we had any tools to look inside the human brain and you know, before we understood the impact that the brain had on what you do, but also what the impact in reverse because what you do changes your brain and can change your brain for better um, or for worse. Now, the teenage brain, there's there's kind of that there's a little bit of a dilemma for me there. The teenage brain and and I'm talking from adolescence actually through to the age of 24, goes through a critical period of development. It's the second critical period of development. The first is from the age of two to seven. But between the ages, whenever you kind of hit puberty and right up to 20 to to to 24, your brain basically remodels itself. It remodels itself from back to front. So the last part uh, to be remodeled and to mature, um, is also the last part that evolved in humans and that's the frontal lobes. And when you understand that, you then understand why why teenagers take risks, make poor decisions, don't learn from mistakes. They actually don't have the tools. You know, that frontal lobe is not developed and they can't. And also their brain is dealing then with this rush of hormones that that come out at puberty that the brain has never had to deal with. And hormones are chemical messengers and you have receptors for those messengers all over your brain. And so the poor teens, like they really are all over the place. And I do think we need to parent our teens more than we do now. Do you know, there's a lot of parents, you know, you're kind of giving too much. I think they need support to gradually learn, you know, um, you know, how to kind of function and and become an adult and assess risk. And that kind of comes with time. But one thing that's really positive about the teenage brain or interesting that relates to learning is that neuroplasticity, the ability of the brain to change with learning is enhanced in the teenage brain. So it's a great time to learn new things and it's very important that that brain is stimulated at that point because there's also an awful lot of pruning goes on, which is literally taking away neurons and brain cells that aren't being used. So it's a use it or lose it. So it's very important from that respect. But that learning doesn't have to be just academic. That learning means that they're enhanced for, you know, learning about the world, how it works, learning to be human, all those things. And I just think that actually going to university straight from school is not the best thing. Now, it depends on what it is you want to study. But you know, that's when you want to sew your wild oats. That's when you want to party. It is actually the time when you're learning how to be human. You're learning how to interact with people. You're learning by mistakes and boy, you make a lot of mistakes. But that's how we learn, you know, I hate that the word failure has a negative consequence or connotation. Um, you can't learn without failing. That's that's how the brain learns. It's trial and error. The only problem when it becomes negative is if you if you take that first error as an end result, it's not. That's just a shaping of the behavior, you know. Um, but I really think kids should, you know, look, give all kids a place in university. Let them go off, discover who they are, what they really like, find their joy is what I call it. You know, that thing that they where you lose yourself. I I just firmly believe that if you find the thing that you love, um, that's how to find yourself because you lose yourself. I know listeners it sounds crazy, but if any of you have ever found yourself engaged in something where hours pass and you don't notice and people could talk to you and you don't notice, uh, and you've just enjoyed it. That to me is finding yourself. You're one with yourself, but you've kind of lost, you've lost the the self that your brain has created from information uh, that it takes in and often that information is erroneous, you know, like some teacher told you you'd never amount to anything and that niggles at the back of your head. So you lose all those kind of constructed notions of yourself and you're just, you're just one with yourself, you're present. Um, and I think that I think it's much more important for when we're younger to explore and find those things and then find out whether, number one, whether you want to go to university because I don't believe that, you know, everybody has to or or needs to. Um, number two, if you do go to university, what you actually really might like to study. And there's another reason why that's really important because curiosity, um, when you have an intrinsic curiosity, when you are naturally curious about something, again, neuroplasticity is enhanced. So it's easier to learn about something that you're naturally curious about. And the fab thing about that is as well that even if you then if you move, and I've said this on my own podcast, that enhanced ability to learn continues for a bit after you switch from the thing that you naturally find interesting. So I just think teachers should just let kids, you know, invest 15 minutes in something that they're naturally curious about and then go, right folks, we're going to do the theorems now because your ability to learn is enhanced.

Dr Rupy: That's such a good, that's such an interesting new model of teaching because quite like even now when I was doing my masters in in nutritional medicine at University of Surrey, I it was very didactic. It was like an hour long lecture and even if I was like interested in the subject, that wanes after about 20 minutes.

Dr Sabina Brennan: It does, it does. Yeah.

Dr Rupy: And you just need a break, you need something to refresh your learning uh, capability during that because we're not, I just don't think we're designed to sit down for 60 minutes and try and.

Dr Sabina Brennan: We're actually not really designed to sit down full stop. Yeah, exactly. Our bodies aren't really. But actually I did a I was a guest on a radio show here in Ireland and if anyone's listening who is kind of studying, I did some sort of tips from neuroscience around studying and I talk about that. Like attention naturally wanes after about 30 seconds. Naturally. So it just naturally it will it will drift unless you actively sort of pay attention. So, um, and the crinkly part of your brain, the outer part of your brain, the neocortex is the most energy heavy. It require anything that that uses that part of your brain requires a lot of energy. So that's things like, you know, paying attention, focusing, decision making, problem solving, language, holding conversations, social interaction. They're resource heavy, you know, and you do feel tired after it. So like that, if you're listening to a lecturer and you're actively paying attention, that's tiring and you definitely should have a break after 30 minutes. Some research suggests possibly 90 minutes because a lot of our our our our rhythms in our body do seem to have a 90 minute, you know, the the the cycles of sleep are, you know, kind of 90 minute sort of segments. But definitely there should be a break, definitely there should be standing and moving around and actually some sort of interaction rather than just, I mean, I this is something that I'm kind of passionate about as well and I often say to people, you know, if you want to enhance your memory, use all of your senses. You know, if you look at a baby or toddler interacting with the world, they use every sense. Stuff goes into their mouth, into their ears, you know, they roll on stuff. And then they go to school and they're told to sit down, you know, fold your arms and just listen, you know. And what that happens is, like, you know, information when it comes into the brain is enhanced the more senses you use. And it also means that when, you know, a memory is being embedded in the brain, you know, consolidated, like there's this old model, like the way memory we talk about memory, we we we talk about it as if there's like a store, like a place where all your memories are kept, like a physical place with a box. But it's not. Your brain communicates by electrical and chemical signals. So memories are patterns of electrical activity that can be activated or triggered or retrieved. But that's how your brain communicates, electrical and chemical signaling. So if you, the more senses you engage, and and roughly speaking, your different your senses are located in different parts of the brain. So vision at the back of your head, language on the left side, um, you know, movement on the right, you know, you know, that's I mean it's more complex than that, but broadly speaking. But then if you engage more of your senses, those networks of memory, that pattern is going to be across all of those rather than just across language. And that's really, really important if you're uh, unfortunate enough to develop a um, a neurodegenerative disease like dementia in later life. So language is often impacted and if that's your only access to a memory, that means that memory is gone. But if you've been engaging all of your senses, language is just one part of it and so you can reignite memories through sound and smell and and and other things. So I think we kind of have to relearn to re-engage our our our senses. Plus, it's good for your mental health because you get much more, you get much more out of life, you know.

Dr Rupy: Absolutely, absolutely. You know, that that brings me full circle to the thing that you were talking about earlier about teenage brains and the frontal part of the brains and how they're still developing and how with certain types of dementia, frontal lobe dementia, you see that disinhibition. And the disinhibition is sort of what you see in. I mean, it just I just put the dots together now where you see with kids who are who are adrenaline junkies and you know, they don't see the risks inherent in whether it be, you know, substances or uh, activities, sports, all that kind of stuff. They haven't developed that sort of inhibition.

Dr Sabina Brennan: Yeah, and to disinhibit behavior is quite resource heavy. Like, you know, it takes a lot of work. And it kind of is like I'm kind of fascinated with the concept of what some people might call personality or self, you know, and and essentially an awful lot of those, again, they're patterns. The brain loves patterns. And really our personality is our patterns of behavior. Um, and you know, a lot of those are like, we're not the same person with our granny or our mom as we are with our mates. And you know, your brain is brilliant. Like it learns through those patterns. Oh, you can't say fuck in front of mom. No, but you know. And and that's kind of, you know, hard work, but it it that's for me is quite interesting because it's that your brain just learns all these things. They're learned behaviors and learned patterns of behavior. But I think is really positive if you do have patterns of behavior that are causing you harm, whether it's poor eating habits, whether it's, you know, mental health issues or whatever, you can re-relearn, you know, and retrain your brain for new, more helpful or more healthy, um, patterns of behavior, but they, you know, I mean, the old patterns don't disappear. They're still there and they tend to resurface with in times of stress and poor sleep. But um, I I think that's kind of very liberating to kind of, you know, to kind of realise that your brain, your brain constantly scans for patterns of behavior, actually just to be um, efficient. So basically, I think this is why a lot of people, um, during lockdown have experienced brain fog. So obviously that's what my latest book is beating brain fog, but I, you know, that was in exist, well, not in existence, it wasn't written, but I had, you know, I had got my book deal to write it long before COVID existed. But, you know, brain fog has come to the fore now because uh, people with long COVID are experiencing brain fog, but also pretty much everybody was experiencing brain fog, having trouble concentrating. Actually, a lot of people even have said to me, you know, I've never done so little in my life in terms of I'm not entertaining, I'm not socializing, I'm not doing XYZ. And my brain is completely underperforming. I feel exhausted every day and I can't, you know, I can't do my work as efficiently as or as effectively as I used to. And I say, well, look, here's, obviously there's stress impairs your brain function, so too does disrupted sleep, which most of us are experiencing this last year. But I think the main thing is that if you think about this, right? So your brain only weighs 2% of your body and it consumes 25% of the nutrients circulating at any time. So it's a high energy organ. And basically, um, in order to use that uh, the resources that are available to it efficiently, um, what it does is it it it scans your behavior for patterns, okay? Um, patterns that it can automate. So the outer part of your brain is the conscious part of your brain, the most resource heavy, the thinking part of your brain. Underneath that, if you turned your brain upside down, you have a part of the brain called the limbic brain and it's um, uh, often referred to as the emotional brain. And that's unconscious. And then below that, you have your brain stem, which is also unconscious and often it was the first part of the brain to evolve and it manages things that you don't have to think about again, like breathing, heart rate, digestion, that sort of thing. So basically, your brain in order to be efficient, scans your behaviors. So I'm talking things like, you know, pre-pandemic, you know, alarm goes off, get up, go, have a pee, have a shower, sing, whatever you do, brush your teeth, breakfast, dress, you know, and often, you know, it could be 9:30 before you really actually consciously uh, engage in a behavior that requires your thinking brain. So that's a whole routine of a pattern. And your brain just loves that. It goes, and it hands over responsibility for that entire routine to a part of your brain in the emotional part of your brain called the basal ganglia. And it becomes automated, unconscious and effortless. You don't have to think about it, okay? So you go back to March 2020 and we were all told to go home and figure out how to work. Well, most of us, some doctors weren't. But um, you were told to go home and basically what people did was, so they had an additional challenge, how to figure out how to work at home, you know, but also most people just dropped their routines completely. Um, to the extent that people, certainly in the first lockdown, sort of acted as if it was um, Christmas and they're staying up late watching Netflix and then lying in in the morning and then maybe some people had to homeschool and you know, maybe starting, you know, starting work at different times during the day and maybe taking a break to to take some exercise, go for that walk we were allowed to do and then maybe homeschool and then maybe work in the evening. So the brain couldn't even, so number, so so pre-pandemic, about 40% of our behaviors were habitual. Okay? So that's what these are, we you and I would call those automated behaviors, is habits. And then you think the pandemic hit, pretty much most of those habits were dropped. So your brain is just overwhelmed with stuff it has to think about. And then on top of that, you're not engaging in any behavior in any sort of patterned way. So your brain can't find new patterns to automate except some of the bad ones we picked up like 6 o'clock, do you think it's too too early for a gin and tonic? You know, and sit and watch TV and eating junk. And so actually those became habits far quicker than they may, you know, they they they may not have. So my the I think the solution to that is really, really simple. Just reintroduce your your your old routines. Just go for it and go I I suggest to people, you know, take a commute in the morning and one in the evening and I even suggest, you know, have a shower after you finish your your day and change clothes because if you're having work and home in the same place, it's kind of a good idea to to um, kind of separate the two. But um, yeah, yeah, well at least you're you're kind of in the UK, you're kind of going back.

Dr Rupy: Yeah, yeah. So we're we're we're going back to normal uh, generally over the next couple of weeks anyway. But I totally get your point about those uh, habitual routines. I mean, even for us going to work was a completely different environment. We had different areas to get used to. We had different, obviously, uh, equipment and stuff and PPE rules and the guidance was changing all the time. So it was a constant sort of headache where your head space was being filled with all these new protocols.

Dr Sabina Brennan: Yeah. Well, it's new it's new behavior and the old habits are gone. So it really is, it's like it's just a resource issue. It's overload. I haven't haven't got the resources to figure this out.

Dr Rupy: Yeah, it's interesting we're talking about this because uh, in my latest uh, pod, I was talking just on on my own about how I habituate certain patterns in the morning such that I don't overload my decision-making capacity. And so I I literally, I know what I do. I do my meditation, I do some exercise, I do my obviously personal hygiene routine and all that kind of stuff before I start even looking at my phone where I'm going to get a barrage of texts and emails and all that kind of stuff. And the other thing, just before we move on, um, one of the things you you mentioned about learning and our capacity for learning. One of the things that I found really useful about podcast in general is that when you put your earphones in and you go for a walk, you're being um, sort of hugged by a whole bunch of different stimuli, whether it be you're walking outside, the trees and pictures. And because podcasts are like just someone having a conversation with either you or someone else, it's very easy listening. And I think that for me is a really nice way of learning things. And and you've got your own podcast, right? The the Super Brain podcast.

Dr Sabina Brennan: Yeah, yeah, Super Brain podcast. Yeah, and we were just talking kind of before, I love it. You know, I didn't realise how much I would love it. It's I mean, for me, certainly on my podcast, when I interview guests, we talk about thriving and surviving in life and I just love the intimacy of it and I the the feel that I want for my listeners is that they're there with me and and my guests, they just happen not to be speaking. Do you know that they're just part of the conversation and and you know, a lot of people, a lot of people feel that. Um, and um, I think it's especially as well, I think during lockdown, social isolation, um, you know, is a is a is a big issue. It's a it's a big health issue. Um, we tend to think of it as something that maybe that affects older people, but pandemic aside, you know, social isolation affects people of all ages, loneliness. Um, and um, I think it's a way to feel connected, you know, to to to you know, if you you know, in the absence of being able to be connected, you know, in the physical world with people for whatever reason, um, I think a podcast gives one of the closest things um, to kind of that social intimacy that we need, that we need for survival. I mean, I I you know, I I think I did a I also do some little solo episodes where I explore a topic from a neuroscience perspective. It's pretty much like I'm just talking to you, you know, now. But I think I've done one on loneliness and I actually give talks about loneliness because I'm, you know, it is a big issue. Um, and um, you know, basically loneliness is it's what in psychology terms, we would call an aversive signal, right? So that just means it's an unpleasant signal, unpleasant. So hunger is an aversive signal. Thirst is an aversive signal and the purpose that it serves is hunger serves a purpose to say, you need to eat. You know, your brain needs fuel. You need to eat, right? And and you know, there comes a point where you get so hungry, you say, no, I can't do anything else. I have to eat. Um, I won't be able to think, you know, and that's because your brain actually isn't getting the fuel. Similarly with thirst, you know, it's all in the interest of survival. Loneliness is an just a signal just like hunger that says you need to get connected. Um, but for some reason, we ignore that signal. And because there's something about and I do think a lot of it is around, you know, the books we read, the the the TV shows that we watch, you know, that people who are lonely are portrayed as somehow less than others. I mean, I I do a thing when I give a talk on loneliness and I say, hands up if you've never felt lonely. Now, they've only once had one person who put their hand up. I'm going to go, okay, that's a bit weird because my response is is if you've ever felt lonely, it just means you're human. That's all it means. And you need to take action and it's really important that you take action sooner rather than later because it actually changes your brain and it changes the structure of your brain and how it functions. So basically, we're meant to be, we're social creatures. We need other, we need other people. Plus, social engagement is a really stimulating activity for your brain. It's brilliant for brain health. Like it's it's it's one of those things that I advise that you need to do in order to keep your brain healthy is social engagement. But when you go to sleep, when you've been socially isolated for whatever reason, uh, your brain, which is still talking, you know, from our evolutionary learning, it's still operating from that perspective, goes, oh, you're you're you're a bit of a risk here, you know, there's no one else in the social group here to look after you when you go asleep. So actually it interferes with your sleep and you won't go into a deep sleep and you need a deep sleep because that's where not only the, you know, we talk generally about restorative, but if you don't sleep deeply, you know, your memory function will be impaired because that's when memories are consolidated. Um, your hippocampus, which sort of is acts like a temporary repository for information coming in during the day, that won't get cleared out properly, so you'll struggle to take in new information the next day. But probably even more importantly is your brain, um, as I've mentioned, is a really high energy organ, so it produces a lot of metabolic waste and it can't clear that waste during the day. You know, the rest of your body produces metabolic waste and your lymphatic system clears it away. But your brain can only clear a little bit of it. So essentially, really, it needs you to go asleep so it can do like the bin lorries going around at nighttime on empty streets. You know, it hasn't got the resources to clean while you're using your brain. So when you're asleep, it can do that deep clean and clear those toxins. And people often say to me, how do I know if I've had enough sleep? And I say, well, if you wake in the morning feeling refreshed, that's a pretty good indicator. If you wake feeling groggy, you know, chances are you've still got metabolic waste, um, you may have adenosine, which is the um, sleep pressure chemical, you know, so you'll feel tired. Um, but also, like one of the toxins, um, that builds up with sleep is beta amyloid and that's one of the key, um, the the the key, it's one of the hallmarks of Alzheimer's disease and we know that there's a link between poor sleep and and risk for Alzheimer's disease, but uh, and we don't we, the royal we, you know, scientists, you know what I mean by that? The literature says, but basically, um, you know, it's not clear which way the, you know, whether, you know, poor sleep is a consequence of the build up or vice versa, but either way, sleep is one of the most critical um, things to to human survival and human brain function.

Dr Rupy: Even if it's not proven out uh, specifically through, you know, uh, Alzheimer's, there's definitely an association there. We know it has an impact on appetite regulation, sugar balance, inflammation at large, you know, there's so many other reasons as to why you need to really prioritize sleep.

Dr Sabina Brennan: Oh, absolutely. I mean, you you you eat more the next day if you haven't had enough sleep. And you crave those calories from fat and sugar. Yeah. You know. Um, and actually even now you're the the medical doctor, like I think it only takes four or five nights of, you know, less than four hours sleep for you to go into a pre-diabetic state. Oh, yeah, yeah. You know, that's that's and and type two diabetes, you know, um, uh, impairs cognitive function, you know, and brain fog is a, you know, is a key kind of symptom of of type two diabetes.

Dr Rupy: It's almost like these things should be um, health, public health messages in the same way we recommend people limit alcohol and quit smoking. You know, we should really be talking about fatigue as a as a as a grander thing because it has so many connections with with disease.

Dr Sabina Brennan: Absolutely. And if people want to go into my website, superbrain.ie, I actually got a million euro after I did my PhD, very naively. I I knew for anyone listening after you get a PhD, certainly nowadays anyway, um, you know, you don't walk into a job in university, you kind of you have to you have to basically apply for funding to see if you can get money to do some research and and get a salary. So as soon as I finished my PhD, I applied for funding and naively applied to be a coordinator on on an FP7 project for the European Commission, which apparently really is aimed at people who have about 15, 20 years experience and been running their lab. But anyway, basically it was something because I had a I suppose that communication background, that acting background and Yeah. and the science. And to be honest, when I was in doing my PhD, uh, you mentioned earlier that, you know, some of the stuff from the PhD came through to my book. Really doing the PhD is what pushed me more into this side of things, the the the communication and the translating complex science because I couldn't believe when I was doing my PhD that there was so much literature about the fact that, you know, there are risk factors for dementia that are lifestyle, you know, modifiable things that you can do to reduce your risk. I mean, we know now that about 40% of all cases of Alzheimer's disease are attributable to like 12 modifiable risk factors, things that you can do something about. I mean, we could, you know, we could really, you know, reduce the incidence of Alzheimer's disease. Um, now back at that time when I finished my PhD was back in 2010. So basically, um, the the European Commission were looking for someone to basically do an an infomercial about how brilliant their investment in health research was. So I just wrote a proposal and said, you're mad. Nobody'd be interested in that. That's just a waste of taxpayers' money. But here's what um, they might be interested in. I said, in the European Commission, you have committed to adding two extra healthy years to our lives. So we're all living longer, but we're not living healthier. So those extra years we're getting, particularly for women, are what because we live longer, but they're characterized by chronic health conditions, most of which again are preventable because they are lifestyle induced. Um, but I said, look, in order to speak to your overarching goal of adding two extra healthy years, one of the best ways you could do that is to promote brain health. And nobody was talking about brain health in in that context. In fact, even when I was doing it, I was kind of going, cognitive health is what we were kind of talking, you know what I mean? And I kind of I thought, oh no, if I'm going out with the message, I need to use a word that everybody understands, you know, like the brain rather than cognition. Um, but um, yeah, I said, look, here's what I suggest. Let's go out with a brain health awareness program, um, and within that, so that overtly that, provide people with information about how they can keep their brain healthy, how they can reduce their risk of developing dementia, etc. And you are doing amazing research in that area. You're funding amazing research in that area. So let's thread that research through the public health information. And they gave me the money. And um, and I did it and it's still exists. It's called hellobrain.eu and it's a website full of information on how your brain works, how you can keep it healthy. And it sort of started me on the animation route, um, because when you get this funding, kind of funding from European Commission, you have to, you know, have at least three European countries involved and and you know, whatever. So I worked with fabulous animators in the UK, um, and I found animation is just a great way to get complex information across to people. Um, and I've gone on to kind of make animations around all those various topics. But um, all that stuff is there free and um, you know, if anyone wants to find out more about brain health and how you can keep it and and how your brain works even. I see that's I I just think, I just think, you know, we should be taught in school how our brain works.

Dr Rupy: Oh, 100%. Yeah, 100%.

Dr Sabina Brennan: Yeah, exactly. You know, we're trying to figure out who we are, what's going on in the world. You know, if you just knew how this worked, life is much easier.

Dr Rupy: Things would make sense. Yeah. Like if you knew that when you were a teenager, this is why you're feeling so irrational or why you're feeling so anxious, you know, it makes sense. And and the fact that you're still developing, there's sort of like at the end of the tunnel as well. It's like, don't worry, you're not going to feel like this all the time. It's just that simple explanation. And I think, you know, we are mature enough to understand that at that point as well when we are teenagers.

Dr Sabina Brennan: But kids are. Look, I trialed a I I I trialed because I'm passionate, you know, and I'm always trying to figure out ways to do stuff and and I trialed, I've done up like a little brain health for kids program, like a six-week program for kids at school. And I trialed it in um, what we call their dash schools. So it would be a school where kids are from very poor backgrounds, you know, some of them wouldn't, you know, we don't have school dinners like you have, you know, um, but these kids would be given food because they wouldn't be getting, you know, you know, food at home and you know, maybe their parents would have addiction issues and there might be electricity at home or whatever. So I said, well, if I'm going to see if this works, I'm going to see it in whether it works in one of the most challenging areas. And it fits beautifully with the things they're learning about in school. And this is kids about age nine is just about right. And oh my god. So I gave them a talk about the brain and brain health first and they just it's very simple. You know, like there's one week is about, you know, um, physical exercise, you know, and and how that makes your brain work better. And and they're perfectly capable. I talk about brain derived neurotrophic factor, which is BDNF, but but but I talk about it as miracle grow for the brain. It's just like a fertilizer. It just helps helps the cells grow. Well, I gave them a little talk and sat down. I always do Q&A and I sat down on the floor with them. They all sat down. Well, you know what the questions, they were brilliant. They were brilliant and they really stretched me some of them. You know, when such and such happens, what's happening in your brain when that happens? You know, and like there's there's certainly have the capacity to understand it. Like it's not complex. I think and that's what happened to me basically, um, you go into academia and everything really revolves around academic publications and I just, I just felt actually really in a way felt kind of ethically and morally compelled that to share this knowledge. Like I kind of went, how come I don't know that that that dementia has these risk factors that I could actually reduce? How come I don't know that? How come everybody doesn't know that? And then I kind of went, everybody has to know that. This is not fair.

Dr Rupy: Absolutely, absolutely.

Dr Sabina Brennan: And um, yeah, and and and so, um, yeah, I I mean, I have obviously published academic papers, but I think it's just far more important to take that science and give it to people in a way that they can understand it.

Dr Rupy: Which is why this book is fantastic, Beating Brain Fog, because it's getting the messages across in a way that's very uh, accessible for people. It's shareable as well. There's a simple plan associated with it. And I think like you said at the start, a lot of people can explain to you what brain fog is to them, right? Everyone has experienced brain fog in some way or another. As a GP, I get this all the time. I just get slow brained and stuff. And you know, the constellation of symptoms that you talk about, I reckon a lot of people reading this will identify with it immediately. Like, that's me. And the explanation as to why people might be suffering from that as well. So why don't we start right at the right at the start and and describe exactly what we mean by brain fog.

Dr Sabina Brennan: You want me to describe? Yeah, yeah, yeah, yeah. Um, absolutely. So I mean, I use brain fog as an umbrella term, um, to describe a collection of symptoms. And as you said, they're symptoms that most people will have experienced on and off, you know. Um, uh, so it would be lack of mental clarity, uh, trouble focusing, trouble paying attention, trouble concentrating, a sense that sort of everything has slowed down. It's taking you longer to to get what somebody just said, figure it out and formulate an answer. Issues with memory, you know, um, you know, forgetting to do things or, you know, not recalling what you did this morning. And a lot of people with long COVID that I've spoken to say, I can't even remember, like what I had for breakfast. And I remember one woman saying to me, my father visited this morning and I don't remember it, you know. Um, uh, learning and learning and memory are inextricably linked. My my tongue and teeth aren't working properly this morning on the big words, but there you go. Um, but um, because learning really is the first step in the memory making process. You have to learn information and and there's those connotations of it being academic learning, but your brain just taking information in is learning about that information and then that can be kind of consolidated. Language issues are very common. So the word finding issues, but also substituting the wrong word. And then also a general sense of when it comes to language that um, uh, maybe your your language isn't as rich as it ordinarily would be or it's not flowing as well um, as it would. Uh, and then one that people are often surprised about is um, clumsiness would be the lay term, you know, we'd kind of say problems with um, spatial navigation and people tend to think that's a physical thing. But your brain is constantly assessing the distance between you and the furniture and the doors, um, you know, around you, uh, so that you don't bump into things. And so when that goes off with with brain fog, you will find yourself bumping into things or dropping things. Um, and then that mental fatigue and I think it's, I'm doing some work actually with multiple sclerosis, um, internationally, uh, at the moment really to try and um, get consultants to consider more around the brain fog that people with MS have, you know, the cognitive function that their brain health is critical because there tends to be a focusing on um, the physical um, and visual uh, aspects of it. And I think it's really important that we distinguish between physical fatigue and mental fatigue because they are two different bodily symptoms. And yes, physical fatigue, you know, your body will feel tired and you know, you can feel the glucose build up in your muscles or whatever and you know, you you um, you you need to sleep, but you may still be able to function cognitively. With with with mental fatigue, you don't necessarily have any physical tiredness. It's really just that and this is the way I would describe it. I'm just too tired to think. I can't. I just can't. I I I just can't do this. Um, and the thing then with mental fatigue is it actually changes your perception of how physically tired you feel and it changes your duration, your endurance to actually feeling physically tired. So if you're mentally fatigued, you will feel physically tired sooner than you would if you're not mentally fatigued. And I think we hear a lot about fatigue associated with various mental with various conditions. We're hearing a lot about it with COVID, but a lot with autoimmune diseases and inflammatory conditions, etc. And I think it's important to separate it out because I think a lot of people think fatigue is just tired or a bit more than tired, you know, and and there's a sense that, oh, well, look, you know, get up and move about, but it's not that, you know, it's the mental fatigue that really um, impacts on it. But what I should say about is is about brain fog is everyone will have experienced probably all of those things I've just outlined at some point in your life. You know, if you've ever had jet lag, you'll experience some of them, you know, if you've had disrupted sleep, if you've been burning the candle at at at both ends or if uh, you're you're stressed or working too much. But the thing about brain fog is that it's um, persistent. Uh, the symptoms occur regularly and they actually interfere with your quality of life or your ability to carry out your job or relationships even. Um, and there's many underlying um, causes and I kind of divide them. I basically the way I describe brain fog is it's not a disease or a disorder. Um, it's not a condition in and of itself. It's very real. That doesn't mean it's not real. It's very, very real, but it's not a disease. It's a sign or a a signal, it's a warning sign that something is amiss, something's not going right in your brain because your brain normally functions seamlessly and that's why people forget about their brain as an organ. Um, so it's a sign or a signal. I often kind of use the analogy like a cough. So, you know, if you have a cough and say, uh, you can link it to, oh, I've been talking for three hours or, you know, or um, actually my mouth is dry. I I need to to take some liquid or I have a bit of a cold. Um, yeah, you know, you can link that cough and it will it will it will resolve itself when you drink water or when the cold is gone. But if you have a cough that persists over a period of time and then impairs your ability to function, for example, you can't finish a sentence because you cough. When you go to bed at night, you're woken up because you cough and that then is interfering with your sleep, etc. You know that that's a trigger that you should go see your doctor and your doctor will then go and see if they can find an underlying function, an underlying cause, which could be a chest infection, but it could be other things that are more sinister as well. Um, and my feeling is that if you go with brain fog, the response should be the same. You know, well, okay, let's see what's underlying this because it can be many things. And I think a lot of GPs and I'm not put, you know, I'm not tiring all GPs with the same brush. My own son is actually on the GP training scheme. And actually I was looking he really, he really wants to do emergency medicine. Oh, amazing. Just loves it. He's in A&E at the moment and just loving it. But also actually just as you say that, he he uh, he did a first degree and then did medicine. So he studied medicine as a mature and got much more out of it. Um, you know, anyway, I'm digressing. But um, yes, I do think, um, you know, that that that and that's part of why I wrote the book as well is, you know, that I wonder sometimes whether GPs see the brain as within their remit. You know, and I if it's not within their remit, who is, you know, it's just another organ in the body and I think part of the problem and anyone will find if they read any of my books, I don't refer to the concept of mind. I I actually call it an unnecessary middle man. It's something that we it's a word, it's like a linguistic construct to explain behavior before we had the technology to actually look inside the brain and realise that actually our thinking is a behavior, you know, our emotions are behaviors and they all, you know, are results of electrical and chemical signals and influenced by what we eat, etc. And I just think that perhaps with GPs, they're thinking more about the mind or even cognitive functioning rather than, well, no, hold on, there's an organ here and this is just, it's no different than a heart beating differently. Um, and lifestyle plays a huge factor. So just for listeners in terms of underlying causes of brain fog, so one of the things that they can be is is a symptom of an underlying health condition. And they tend to be chronic conditions. So, um, autoimmune diseases, inflammatory conditions, chronic pain conditions, um, depression, anxiety, uh, chronic pain conditions, uh, some cancers, um, uh, and then they also brain fog can really quite easily be, um, a side effect of a medication. And many, unfortunately, many of the medications.

Dr Rupy: Which incidentally, all the things that you just mentioned there are all within the remit of general practice. These are literally the things that we see on a day-to-day basis.

Dr Sabina Brennan: Every day. And actually, you know, the thing is what and I do say this in the book is that, you know, if you go with and I have autoimmune disease and I have migraine and I have, you know, and I have experienced brain fog myself. And often I will say to people, look, it's often multiple things. And for me, actually, my brain fog was the worst when I was doing my PhD because I was perimenopausal, um, you know, I had Sjogren's, I had chronic pain, I had migraine, and then I was under extreme stress doing a PhD. So that's kind of when it, you know, it it really, I really was concerned. But um, often as well, you know, GPs will go for that tangible. I mean, I remember when I was tutoring students, I was tutoring them about behavioral science and they just thought it was kind of iffy and and you know, kind of too ephemeral and they wanted the the physiology. And I'm kind of going, but actually it is. This is all electrical and chemical signaling, you know, this is just what the the the behavioral responses. But um, uh, yeah, the the the GPs and the consultants and I mentioned MS, you know, um, that's an underlying health condition that's that's that's frequently. So I I should have said yes, neurodegenerative or, you know, um, um, conditions that affect the brain itself. Um, uh, but like that, you know, they're more concerned about, you know, mobility, whether the person can walk, etc. But often and and even on diagnosis, people with MS worry that they'll end up in a wheelchair and won't be able to work anymore or they'll lose their independence. But actually the research shows that the main reason they have to give up work and lose their independence is through um, cognitive fog, brain fog. You know, that's the main reason because if you think about it, we have ramps and all the rest and anyway, as well, the the the medication for treating MS has just come on in in leaps and bounds. Um, so people are actually doing much better, um, uh, with relapsing and um, remitting MS anyway. So the unfortunately then the other thing is, um, that can lead to brain fog is medication, side effect of medications. And unfortunately, side effect of many of the medications used to treat the conditions I've mentioned do give rise to brain fog. And basically any medication that operates on your central nervous system has the potential to impact on your brain function. It doesn't necessarily, they won't often do that. And I I I say over and over again, look, if you think that a medication is leading to your brain fog, never, ever, ever stop taking a medication that's been prescribed for you. But do go and talk to your GP because there may be an alternative that actually won't have those symptoms. And people will have heard of chemo brain and chemo fog. Chemotherapy gives rise to uh, to brain fog. But people may be less aware that antihistamines, uh, anti-nausea tablets, uh, painkillers, uh, antidepressants, they can all give rise uh, to brain fog.

Dr Rupy: It's actually one of the reasons why I'm sat here sniffling away because I've uh, I've used antihistamines in the past for my hay fever and my hay fever is relatively mild, but I've had really severe brain fog as a result of using um, cetirizine and I've even tried the non-sedating ones, loratadine and fexofenadine in the past. And I remember the first time I experienced it, I was actually uh, about to deliver a lecture uh, culinary medicine in at Bristol University uh, to the medical students there. And I I popped a a pill before and I just, it was just treacle in my brain. I just couldn't interact with the kids and I I call them kids, they're students. But like I I just couldn't I couldn't, you know, converse with them and stuff and I knew straight away I was like, I know what it is. Uh, I'm luckily I'm aware of the potential side effects of it.

Dr Sabina Brennan: Yeah, yeah, I don't take it because like that, yeah, I mean, I used to take um, I've taken various medications over over the years and it is that payoff often, you know, um, so when I had um, really bad pain several years ago and I was prescribed uh, pregabalin, um, which is an anti-epileptic and it made the, you know, I eventually agreed to take it because I couldn't function. I mean, I could barely walk, you know, the pain was just awful. Um, and like that, I had stopped exercising because you think that's what to do, but actually one of my ways out of it was actually exercising again, you know, and actually looking after myself. But um, uh, that can really interfere with your your cognitive functioning. Unfortunately, I will I I seem to have I I think they call what I have when it comes to sedatives, I have a paradoxical reaction. So some sedatives, I mean, I'm obviously a very talkative person anyway, but you give me, you give me some sedatives and sometimes I can just go really high as a kite sort of thing. So yeah, I remember my GP saying to me, how are you even standing upright? You're on this much um, pregabalin. And I said, no, I'm fine, but I do feel my brain is a little slower, but but but I wasn't, yeah, yeah. Anyway, I'm digressing. But yeah, lots of different medications. And so that's part of what I'm doing in the book is to kind of help people, number one, get a handle on what their actual symptoms are so that they can go to a GP and discuss with the GP, well, I'm having this and could it be this, this and this? It's not about self-diagnosis. But um, but also allowing them to go, like that, you know, kind of go, oh, maybe it's my antihistamines. You know, that never occurred to me. And actually, maybe I can live with sneezing more than I can live with uh, you know, the brain fog, which is, you know, I mean, for some people, it really does. I mean, I said earlier, we are our patterns of behavior. And brain fog can change those patterns of behavior and you really just don't feel like yourself. The other biggie that um, causes brain fog are hormonal changes and hormonal imbalance. And that's one reason that it really does heavily impact on women. Lots of women will have had baby brain, pregnancy brain and menopause brain. And that was one big concern for me was that there was so many women of that age terrified that they were getting dementia and catastrophizing that they were getting dementia because they were having memory problems and language problems and sort of afraid to tell anyone. And so the anxiety and the stress makes it worse. They're not sleeping because of the hot flushes, so that makes it worse. And um, I just felt, you know, and and some of them going to GPs and being told, oh yeah, it's the menopause. Yeah, yeah, you know what, it is the menopause probably, but can you explain why it's the menopause that it's not just this, you know, basically you have estrogen receptors in your hippocampus, which is a part of the brain involved in learning and memory. And if that changes, that's going to impact on your ability to learn and remember. But also your lifestyle and what choices you're making impact on how balanced, imbalanced or out of balance your hormones are. And that's, you know, all of those things I've mentioned, chronic conditions, painkillers, hormones, etc. Um, following, changing lifestyle factors can hugely improve the brain fog. Uh, and you know, and and and so many of these things kind of interact. Dietary deficiency is another issue. You'll be well familiar with this, but I feel very strongly, um, and I don't know how you feel about this, but I there's a hundred billion dollar industry in supplements. Uh, a lot of them playing on people's fear of dementia. You know, memory boosting, brain supplements and, you know, just brain supplements and think sharper supplements. You can get all the nutrients and macro and micronutrients that your brain needs from a Mediterranean diet. You do not need to spend a penny on supplements unless you have a diagnosed deficiency. And that would be a vitamin B12 deficiency, um, uh, uh, can cause quite severe brain fog and actually can even mimic uh, dementia, um, in older people. And when you get older, your gut can't absorb, you know, B12 as much. But also then, you know, all these are interlinked. Like if you have a chronic inflammatory condition, if you have Crohn's disease or something like that, you're not going to be absorbing B12 in the same way. Um, but basically, you don't go out and buy B12 supplements. You go to your doctor and you see if you're deficient and if you are, they'll prescribe possibly injections or monthly injections or whatever. And it's a form of anemia. Yeah. So also folate deficiency or an iron deficiency can impact. And a lot of women are iron deficient. Um, you know, if they've have heavy periods or anything like that, you know, they can and that can even kind of change through the the cycle and impact on your brain fog. So if you have those, you know, if you're diagnosed with a deficiency, yes, of course, those supplementations will help. Um, if you're vegan, vegan or vegetarian, you may also need, um, because uh, I think it's very hard to get B12.

Dr Rupy: Yeah, yeah, it's hard to get B12 in a purely vegetarian and vegan diet. And even in omnivorous diets, we're finding that people are still quite B12 deficient and that can be as a result of gut inflammation, which uh, changes the absorption and obviously that uh, plays into anemia at large and why uh, particularly women who are menstruating age are at risk of uh, of uh, hemo deficiency. I was, yeah, go on.

Dr Sabina Brennan: Yeah, sorry, I was just going to say, like it's always it's multiple things. They all kind of feed into each other. And and the positive thing then I was coming to is the lifestyle factors are the key ones. So if if you if you prioritize your sleep, manage stress, exercise your body and your brain and eat a healthy Mediterranean diet, no matter whether you have a couple of those underlying conditions, your brain fog is going to really will clear quite a lot. I mean, you know, and I I mean, I've had people from with long COVID, um, oh, and I meant to say that actually at the start with underlying health conditions, it's really common after any virus or, you know, if you've had sepsis to have brain fog for a very long period of time. You know, and I've spoken to some people with long COVID who've gone to the doctors and said, oh my god, my brain function, I can't go back to work and they say, oh, you know, this is COVID, we really don't know, we're only learning. And I'm kind of going, no, you know that any after any virus, somebody may get brain fog. You know that for up to a year after sepsis, this is just the brain responding, you know, after a virus. It's there's inflammation, there's, you know, strange immune responses, but also there's the resource issue that your brain has just tried to save your life. Remembering where you put your bloody keys or the name of your second cousin is irrelevant until you're safe. Do you know?

Dr Rupy: Yeah, yeah. It's interesting because we we see that with um, post-ICU patients and there's definitely, you know, that post-ICU, so post-prolonged ICU stays where you've had a number of different insults, not only inflammation and infection and and and changing uh, your immune capacity, but you've also had biological clock disruption because you're constantly in an environment where the lights are on and you're being artificially sedated and all that kind of stuff. So it's no wonder in those scenarios you have prolonged symptoms.

Dr Sabina Brennan: And and and oxygen deprivation as well, you know. And it's funny you just say that. Again, I made a series of animations. Well, people have commissioned me, you know, over the years when they see kind of what I've done and actually, uh, it's just when you said that, it came to light. I was asked by a um, would you believe a a neonatal consultant, um, so I'm sure you're aware of this, but you know, if if a baby is born with an unexpected brain injury, so they're expecting a healthy baby and something has happened, the treatment is um, hypothermic, what is it? Therapeutic hypothermia. And essentially what they do is they reduce the temperature of the brain by three degrees for about three days and that prevents any future damage to the brain. And it works very well and very effectively. It's very frightening for the parents, but also what they spoke about is, you know, so basically I was just commissioned to write some animations to explain, do a little animation that explain that and also explain how a neonatal unit works. Um, you'll find them on my uh, website and my YouTube channel. But basically, um, what they were saying was one of the biggest issues is the neonatal units are bright. They're noisy. The baby's brain doesn't get to train. So that's one of the big tips I give if you want to train good sleeping habits, you've got to respond to light. Your brain has evolved to sleep when it's dark and take signals to set its circadian rhythm by daylight. You've got to get out in day, you know, when you wake first thing in the morning, open the blinds, get out in daylight for at least a half an hour every day. Electric lights only around a couple of hundred years. Like our brain has evolved over millions of years. Dim the bloody lights at nighttime from about 8 o'clock. Give your brain a chance. It needs those signals to say, oh, it's nighttime, you know, kind of sleep. And then make your room really, really dark at night and turn these goddamn blue devices off at night. Actually, when I did that thing with the kids, all the different things they were told to do across sleep and exercise and everything, these were the kids in the in the school, the dash school. Um, the one thing they couldn't do was turn their devices off an hour before bedtime.

Dr Rupy: Really? Wow.

Dr Sabina Brennan: Yeah, they couldn't do that. Yeah, yeah, very telling. And it's very damaging. Like, you know, I mean, look, one of my tips, I love technology. I have no idea how it works. Just tell me how to use it. Um, but one of the tips I give to people, you know, for managing exactly what you just said, you you you know, in the morning time, you have your routine, you know, your meditation, whatever. I recommend to people if they feel overloaded, outsource your memory. My memory is completely outsourced to my to to my devices. As soon as there's an appointment made, it goes into the device. If I have an idea for something in a book, I have a filing system and that goes in there, etc. That, you know, that gets it out out of my brain. And actually, if you're anxious and you're worried about stuff, get it out of your brain and put it down on paper. Then your brain doesn't have to keep reminding you about it.

Dr Rupy: Totally. Yeah. I have a second brain for everything. My calendar, if it's not in my calendar, I don't turn up. Like I like everyone knows that around me. They have to book in to my calendar if they want me to be somewhere because I don't want to hold that information. I want to use that, you know, my capacity for other things that I feel are more important. And actually this brings me on to one of the concepts that you talked about, um, so you know, we've talked about brain fog, we've talked about how it's an umbrella uh, constellation of of symptoms that's uh, fairly vague but you know, uh, can be explained by a whole bunch of different things, whether it be medications, uh, hormone fluctuation, uh, inflammation. Brain reserve versus cognitive reserve. I love this this differentiation concept. Could you explain those both?

Dr Sabina Brennan: Yeah, it's a little bit artificial to be honest, you know, but it, you know, it it it does serve a purpose. So, um, basically, um, I suppose I like to think that if you adopt a brain healthy lifestyle, it's like investing in brain capital that you can cash in at some point in the future to cope with or compensate for uh, disease, damage or decline or even something like COVID, right? So it's like building up bank reserves, you know, that's kind of the analogy and actually I talk about it a lot in my first book, which is actually about, you know, keeping your brain young and reducing your risk of developing dementia. But basically, you know, this kind of stemmed from and this is one of the reasons I was really sort of inspired to get into, you know, this kind of area that I'm in is that like a lot of this stuff, I did my PhD in what, what did I say? 2000 from 2007 to 2010. So I'm reading literature from my my PhD and trying to understand, you know, how the brain ages. And then I'm finding literature that goes back to 1986. For example, one researcher called Katzman was trying to understand what was going on in the brains of people with dementia, Alzheimer's disease, uh, and so basically he was looking at people's brains postmortem, right? Um, slices of brain, that kind of way. And um, so he had a control group, okay? So his people with he had the group of people with Alzheimer's disease living in a nursing home who had a diagnosis of Alzheimer's disease. And then he had a control group, people the same age living in a nursing home with no diagnosis of Alzheimer's disease, okay? So he's looking at the brains to try and see what's the difference. And he discovers 10 cases of cognitively normal individuals who have sufficient pathology in their brain for a diagnosis of Alzheimer's disease, right? So they have the disease in their brain, but they don't have the dementia. So I tend to talk about Alzheimer's disease and Alzheimer's dementia. The disease is the stuff, the hard stuff in your brain, the plaques and the tangles that are causing the problems. The dementia is the manifestation of that, the symptoms, the confusion, the memory loss, the language issues, all those kind of things. So how come these individuals could have all that disease in their brain and no symptoms? So basically the concept of reserve, concept of cognitive reserve was introduced to explain that gap. You know, what is it? And over time, there's been just a whole, that's really my area of research that I've worked in and it's spilled over into other diseases now, you know, um, uh, multiple sclerosis and arthritis and various other kind of conditions looking into it. But um, basically, what they found is that that resilience, it's really a resilience to a disease, um, that reserve is linked to uh, certain lifestyle factors. And those lifestyle factors also happen to be risk factors for Alzheimer's disease. So basically, by living a brain healthy lifestyle, you can build up a buffer and it harnesses neuroplasticity as well. So basically, when it comes to Alzheimer's disease, it's not about how much disease you have in your brain initially, it's about how much healthy brain you have. So more is better. So if you have more brain connections, which you get uh, through neuroplasticity and and and doing all the various things that are good for that, bigger is better. So you have more healthy brain that can cope with and compensate with for the disease pathology. Now, it's not a get out of jail free card. Unfortunately, over time, you know, you'll get more and more pathology and you will have less healthy brain and there becomes a critical moment. So often what I explain is, I'm using hand movements here folks and and I know you're just listening, but basically, if you think of someone, say two 65 year olds and they both start to get the pathology in their brain for Alzheimer's disease, one has high reserve and one has low reserve. The person who has low reserve will start to have slight symptoms from very early on and those symptoms will gradually and progressively get worse and that could be over a 10, 15 year period. The individual who has high reserve has absolutely no symptoms, but their the pathology is growing in the brain at the same rate as it is in the other individual. Now, if they both drop dead at 70 and they were in Katzman's study, you would have one who has the disease and the other has the disease but no symptoms. However, if they went on to live longer, eventually the individual with high reserve will actually have a precipitous drop. They'll fall off a cliff edge and they will then sort of catch up with the other individual and go into very severe symptoms. And often people who know people who have Alzheimer's disease would say, oh, when we think back, you know, this was happening over time very gradually and other people say, he was fine and then a month later, like, you know, everything is gone. So the thing is, essentially what we're doing, there's no cure for dementia. So prevention is key. Uh, we have a lot of knowledge about prevention. If you can build up reserves, at least what we can do is change the trajectory of the disease. So you can have more years in possession of your full faculties and living independently at home. And I mean, I don't know anyone who wants to live in a nursing home, do you? You know, you know, people want to live independently at home. And so at least that helps. And pretty much all of those things are within our within our control, um, you know, in terms of of that. So that's so you did ask, I didn't quite answer your question. So cognitive reserve and brain reserve, the the cognitive reserve, so brain reserve sort of refers to the structure. Uh, so the brain cells, the connections between them. And cognitive reserve refers to how efficiently and effectively you can use that structure. Now, initially we used to think that most of the research focused on cognitive reserve, but actually, um, now we're seeing that brain reserve, you know, actually building up the, you know, the the the structure, etc. Um, you can maintain your brain volume as well. So anyone listening there, this is not just stuff that impacts on older people. So if you're 30 or over, your brain has already started to shrink. Um, you know, there's a process.

Dr Rupy: It's a scary thought for a lot of people, you know. It really is.

Dr Sabina Brennan: Yeah, but I hope it's scary in a good way to kind of make you.

Dr Rupy: A good way, yeah, to stimulate action.

Dr Sabina Brennan: Kind of stimulate and kind of go because I think, you know, we all feel immortal, you know, and something like a late life disease, oh well, they're only those old people, you know, I'm not one of those. But you are, you will be, it's just your future self. But basically, from about the age of 30, your brain starts to shrink and you lose a little bit of brain volume every year and then when you hit 60, it accelerates and if you have Alzheimer's disease, you know, it's at a, you know, exponential rate. But basically we used to think that that's called age-related atrophy and a lot of people still refer to it as age-related atrophy and they say it's associated with aging. Now, I'm of a mind that actually, and there I use the word mind, I use it linguistically rather than. But my feeling is that from about the age of 30, we actually stop doing an awful lot of the things that keep your brain healthy. So challenging your brain and stimulating your brain and learning, um, promote neuroplasticity, which means you have denser connections in your brain and more brain cells. So we go to school, we go to college, you know, um, university and then maybe we start jobs where we're still learning on the job. But from kind of 30 onwards, you maybe can start to coast along a little bit so you're not challenging your brain. That's one thing. Physical exercise is really important for brain health. We play sports, we run around when we're kids. Often kind of by the, you know, the time we're 30, uh, you know, maybe we've stopped playing. Even professionals start to retire kind of at that age. Um, another thing is social engagement is critical for brain health. You know, maybe you hit that age and you start to have kids and you're not going out as more, you know, on a plus side, maybe you're not drinking as more, but then again, maybe you're drinking more because you have kids. You know, who knows, but you're not maybe socially interacting. And you know, for me, certainly, we talked about loneliness earlier, the time I felt loneliest in my life was when I had my my babies, you know, um, it was a time long, long, long before um, mobile phones, before the internet. I mean, I was isolated in my home, you know, and you know, my husband wasn't allowed to take calls during the day. Do you know, there really was, there was no way to connect and it's just you and a baby. And again, that's how society has structured it. We measure success by how big a box we can isolate ourselves in. And actually, really, and we see ourselves in a way, you know, as we're, you know, Western society, but we've got an awful lot of things wrong. You know, it's far easier, it takes a community to raise a child. So actually, to be honest, you know, if we were more communal based and community based, you know, um, there isn't that risk of isolation, there isn't that risk of lack of stimulation for for mothers and um, also then you learn how to be a parent by observing other parents because unfortunately it doesn't come with a manual and you're at home and the child is crying for three hours and you don't know what to do with it. Um, but yeah, sorry, yeah, I mean that's just kind of my take on it, you know, that that I I think if we have community and and social integration, um, are important. And I mean, you know, I love the privacy of my house. I'm a talker, but actually really, I'm I'm probably a bit more introverted, you know, when I'm home, I need to be quiet, you know, and I don't like noise around me and I don't like music playing, you know, I I I I kind of can't focus, um, if that happens. So I'm not prepared to give up my house, but I do think we could adapt and have much more central community-based places, but for people of all ages, I'm very passionately against age segregation and our societies segregate. There's no reason, like we segregate by age and by disease. There is absolutely no medical reason that people with dementia should be all put living in the one place. In fact, if you look at the science, it is detrimental to their their health and well-being because they need stimulation. So actually, they go in, first of all, they go into a home and everybody takes away their right to contribute to their own life. You know, they someone cooks for them, someone makes their bed, someone washes them, you know, really, you need to be doing with an individual so that they can hold on to whatever bit of functioning they have. They need stimulation. If you've got 10 people in a ward who can't talk, Yeah. You know, or can't integrate, like it's purely, I mean, I call them the the the leper the leper colonies of our time, you know, and I mean dementia is it's it's not contagious. Um, and there's no reason other than it's a simple uh, economic reason to make more money for the people who who run nursing homes or to make it less uh, expensive. But actually, you know, all care, if people require care and support, whether it's child care, care of infants, after school care, mental health care, there is no reason why that can't all happen in one place and then people learn from each other and we know that when younger and older are together, everybody benefits. And I my own mother had dementia, you know, and I'm even borrowed someone's kid, you know, come visit when mom's here. Because she loved the babies, you know, they love babies. There seems and babies aren't afraid. And also then we can get rid of some of the stigma because people are afraid of people with dementia because they never get to see someone and they never get to realise that this person is still an a human being.

Dr Rupy: I totally subscribe to that um, perspective because you know, there've been studies, I think, where they integrated a kindergarten with an older person's home and they found improvements in their markers of uh, function neurologically. And there was that channel four program as well that actually played that out on screen, which I thought was the most heartening thing I've ever seen. It was so, so well done. I love it. It really pulled at the heart strings. And you the there is science behind this as well. Like you were talking about neuroplasticity and you know, how essentially allows those synaptic connections to grow. And this this actually brings me on to one of the concepts that I I found fascinating in the book was how pain is associated with uh, BDNF that can contribute to poor cognitive functioning as well. Can you explain that relationship?

Dr Sabina Brennan: Um, I'll have to remind me now. So it was more in the context of like how um, chronic pain and people who suffer from that uh, from from uh, ME or chronic fatigue syndrome and or have uh, disabilities that involve pain and how that inflammation can impact uh, brain derived neurotrophic factor.

Dr Rupy: Oh yeah, yeah. And brain derived, yeah, thank you. Sorry. You're right a book and then you kind of go, gosh, gosh, yes. I'm the same. I'm literally the same. I'm like, what did I say? Yeah, yeah, yeah. No, I kind of do know again because I really wanted to put the pain in because there's so many ways that pain can impact on on brain function. But yes, that one, that's the brain derived neurotrophic factor. You know, it's it's it's as I said, it's miracle grow for the brain. It makes a fertile ground for your brain uh, to grow new connections and and that's kind of about learning. So if pain interferes with the release of that, that's going to have a negative impact on on the brain. But also, I think what's interesting about pain is and I think I use an analogy or I sort of speak about it in the book where I say, if I ask you to describe some time when you experienced pain, you don't say, oh, I had a really sharp pain in my right shoulder or whatever. You say, oh my god, I've never experienced anything like it. Oh, I was in the middle of and then suddenly this grasped me and I couldn't even think or, you know, so you have this whole scenario and you had a really sharp pain. So pain is not just uh, our experience of pain rather is not just the experience of the pain itself. It is tied up with emotional experience. It's tied up with um, comparison. So your brain, as I said, your brain, you know, in order to function, you know, it likes patterns, but it also likes to make comparisons. It makes relative comparisons and we do that all the time and it's a heuristic. It's it's a shortcut for your brain. You know, so your brain in order to, okay, there's pain. Is it as bad as when you had appendicitis? You know, and is it the worst pain you've ever experienced? Of course, if that pain is worse than what you've previously experienced, it's always going to be the worst pain you've ever experienced. It doesn't mean it's as bad as someone else's, you know. I mean, kind of it's very difficult. I remember there was a, I'm obviously a young medic training when I was in labor with my first child and he was doing some research on assessing pain levels, you know. Aside from the fact that he came over to lean on me. I'm cringing for him. I'm sure I I know there's a cringe where the story coming up. But you know, he came over with this thing like a, you know, like a a blow horn or like, you know, that you you'd squeeze it and that. Yeah, yeah, and he was listening and I'm kind of going, don't lean on me because he's full weight pushing into my belly. But anyway, he he you know, he's asking me, you know, can you rate your pain on a scale of one to 10? And once 10, you know, but I hadn't gone through the rest of labor. I didn't know it was going to get worse because the worst pain you've ever experienced is the worst pain until you have worse. So it's very hard. But it's tied in with lots of other things, which is why I sort of say to people and why having experienced kind of chronic pain myself, um, uh, that when you have pain, that's again, I was talking to you about attention being a resource heavy um, brain function. So if you're attending to pain, so there's the pain and then you're attending to the pain, you know what I mean? It's using up resources, which means you have less resources left to focus on what you're doing. So certainly what works for me and I I think it makes sense scientifically is, um, I'm not one for sitting around doing nothing. I'm a doer and that gives me great distance from whenever I have pain. And it also makes sense neuroscientifically. So if I can lose myself in something, my attention is not focusing on my pain. It is fully focused on the thing I'm doing. And so I'm not perceiving pain in the same way. Perhaps that pain is there, but I'm not experiencing it in the same way. It doesn't mean that the pain isn't real or whatever, but it's a great, it's a great kind of tool. And I think unfortunately what happens and certainly initially for me when I was having very, very bad pain throughout my muscles and it was related to poor sleep as well. Um, that that I suppose sort of intuitively and probably your brain does, we have illness behaviors which tell us to uh, you know, if something is painful, don't use it and that makes sense to a point. Uh, and so I stopped doing everything except I was a gym bunny and I walked the dogs with my husband every day and this pain just got really bad and so I stopped walking the dogs and I stopped going to the gym and I stopped and actually that makes it much, much worse and you really do start to to seize up. And I just focused on my PhD because that's all I felt sort of able to do. Um, but actually, you know, pain, there's the pain is important for us. It it it tells us when not to use something for a protective point. But then there comes a time where then you get lost. So I use I think in the book the analogy of a broken ankle, um, that, you know, if you break your ankle or twist your ankle or whatever, it's extremely painful. You get your signs of inflammation and and whatever, you know, it's red and it's throbbing and whatever and you have acute pain. And you have to rest it. There's a period of time where you actually have to listen to that pain, put your foot up, elevate it, do whatever, don't use it. And that's where pain works. You know, you go to put your foot on the ground and it goes, but that's telling you don't use it. It needs to heal first. And but then there comes a point where, so you're going to have lost some condition, you're going to have lost mobility and some function. So there comes a point where you actually need to experience and work through pain so that you can use it again. That's that point because if you don't, anyone who's had an injury like that, you know that when you start doing it again or if you go for physiotherapy, damn, it's sore. Um, but you have to do it. Otherwise, you lose it. And and and that kind of happens, I think with, you know, with certain, that's my experience with autoimmune conditions and and you know, that they're actually it really is. And and you know, the advice now for multiple sclerosis, it used to be bed rest. Now it's you got to keep active. Um, and I just think, I think it does, it helps, it helps physically with the, you know, with the pain, actually ultimately does ease, but it also helps to take your focus away from the pain. I think, I think there's a real risk. I think like support groups and all those kind of things serve a purpose, but then there can become a point where people identify with the chronic condition and it becomes who they are.

Dr Rupy: Yeah, exactly.

Dr Sabina Brennan: And it's all they talk about and all they think about and I think that's very dangerous.

Dr Rupy: Yes, absolutely. And I think that's something that's very peculiar to chronic.

Dr Sabina Brennan: Would you agree? Would that be your experience as a GP?

Dr Rupy: I'm glad we talked about that. Yeah, definitely. And you know, I I would like to say it's not uh, it's not everyone, but certainly there is that risk of identifying with this is who I am, this is what gives me purpose, this is what allows me to engage in this community and it becomes your sole focus and it almost sucks you into never really wanting to step out of that either.

Dr Sabina Brennan: Not consciously. This is not consciously at all for the individuals. It just becomes and I think as well, this is again is going back to, um, these are my theories on life really, but you know, no, but we have certainly in Ireland, I don't know how it is in the UK, but we smother our kids in love and attention if they're sick. You know, if they're being good, you ignore them. They're quiet. You know. And and so, you know, we learn through experience and kids learn that when you're sick, there's something special and you get special attention and special treatment. And actually really, it should be, yes, of course, support the child, but give them special attention and treatment when they're doing things and achieving and then illness is something that needs to be recovered from, you know, as soon as possible, rather than something that makes you important or feel loved. And I do think that then that happens in chronic health conditions to an extent that there's a sense of a blending of a feeling of self-worth, uh, and that can serve great purposes, you know, in that people can achieve great things and they can become advocates and all the rest. But there's a really fine line and I think it's something that should be managed, you know, and even made people aware of, just watch yourself that you don't kind of go.

Dr Rupy: Yeah, exactly. Those subtle changes that can reinforce a behavior that might be at the detriment of your overall well-being.

Dr Sabina Brennan: Exactly. It might actually prevent your recovery. It might actually prevent your recovery. Yeah, yeah.

Dr Rupy: We've talked about so many different things. So you know, we're I love how we've unpacked um, brain fog, what it is, the underlying causes. We've talked about some of the things that can help people in terms of exercise, learning, social engagement, Mediterranean diet. Um, there's tons more in your book as well. And I love how you've sectioned them out into different areas of, you know, sleep and exercise and nutrition. Are there any um, other points that you'd want to uh, talk about from your own experience that you've felt have have helped you and your own journey?

Dr Sabina Brennan: I think, yeah, I do actually. There's one thing and it's it's among my favorite tips on on on so obviously I think sleep is, you know, is really critical. But I think this goes cuts across a lot of those conditions and also probably applies during the pandemic that um, one of my favorite tips for boosting brain health is to smile, um, and to have laughter and joy in your life. Um, and thinking back, certainly when I was going through the perimenopause, you know, I must have been shy to live with, excuse me, but like I lost my sense of humor. You know, I definitely lost my sense of humor. I didn't see any particular joy in life. I think during the pandemic, people have forgotten that you can actually have fun even in these circumstances. And the reason I say it is, laughter is is is nature's natural stress buster. Um, it actually lowers cortisol levels. And if you think about it, you know, at some of the most awful points in our lives, you know, I don't know if you've ever lost a loved one, but I know certainly in my father's funeral or whatever, you know, and I don't mean in the church, I mean afterwards, you know, or whatever. Um, that you tell funny stories, you laugh till your belly aches, you know. And I think that's, that's, you know, that's your brain, that's one behavior that has evolved that when the stress is just so awful, it's like a pressure cooker has to be released through laughing. I'm one of those people that if somebody falls up the stairs coming up on the bus, I laugh. My kids, it's terrible. My kids used to say, I fell, mommy, stop laughing. But apparently, they're really close. I can't remember the area of the brain, but they're so close in the brain that the laughter response is like a relief. Do you know, oh, something awful nearly happened. Right. Yeah, yeah. But if you look on social media after there's been dreadful tragedies, it's not very long till kind of jokes emerge, which we're so politically correct that I think sometimes, and I mean, I'm all for political correctness on huge issues, but I think we have to be careful of not throwing the baby out with the bath water and realizing that actually humor is a very great way to cope with horrific tragedy. You know, not laughing at someone, but you know, trying to kind of do that. And smiling, you know, smiling lowers your blood pressure, it boosts your immune function, um, uh, it uh, um, lowers, did I say lowers your blood pressure, boosts your immune function. Sorry. Uh, um, also, it makes your brain, it starts to malfunction. Perhaps I've been talking too long. Um, it also, um, releases feel good factors like uh, serotonin and it also, um, helps the growth of of brain cells. And often people think of smiling as something that's reactive. You know, oh, I've nothing to smile about. Yeah. And and particularly during the pandemic, we're wearing masks. I actually have taken to walking by people and saying, hi, I'm smiling at you, you know, because we're not getting that. Um, but it really bothered me for quite some time, why, so research shows that you can get all of those health benefits from a fake smile and they actually the psychologist did the research by just getting people to hold a pen or a pencil between their teeth. That's what I'm doing now, listeners. And it just puts your muscles into the same um, sort of shape as a smile and it produces all those health benefits. And that really triggered me. How does a synthetic smile, how does a fake smile fool the brain? Like at the end of the day, your brain is supposed to be the most complex known structure in the universe and it's fooled by a fake smile. And then actually, you know what, I woke up one morning and I honestly to God, it must have been one of those nights when I had a great night's sleep and I went, it's because the brain is so clever. It's given us this really, really simple tool to get those health benefits. And just, you know, that's one of my tips, you know, I laughingly say smile five times a day, you know, I prescribe smiling five times a day, you know, once first thing in the morning, it's a brilliant way to start the day and actually it's one of the sleep rituals that I talk about, you know. Nice. Non-negotiable, when you wake up, smile, you know. Smile last thing at night. It is a great way to sort of end the day on that kind of positive feeling. Share at least one smile with somebody else because it's very hard not to smile back at someone who smiles at you. It spreads the health benefits, but it also gets you socially connected. And then I say, you can do whatever you want with the other two smiles, but you know, I I I'm just being funny, but the thing is, smile more. You can smile as often as you want. It doesn't cost anything and actually really fake it till you make it does work with smiling. So especially if you don't feel like smiling, uh, you know, go for it.