249: Brain Optimization and Neurofeedback
with Dr. Andrew Hill
Ashley:
Hello, everyone. Welcome to Cellular Healing TV. I’m Ashley Smith. Joining us today is one of the top peak performance coaches in the country, Dr. Andrew Hill, and he is here to talk about how to take control of your brain health. He’ll discuss the concept of neurofeedback, how it works, and how you can implement it. From general brain health to brain health hacks to mindfulness and supplements, you’ll hear many effective ways to engage the wellness of your brain. First, I’d like to tell you a bit more about our guest. Dr. Andrew Hill is one of the top brain experts in the country. He holds a PhD in Cognitive Neuroscience from UCLA’s Department of Psychology and continues to do research on attention and cognitive performance. Dr. Hill is the founder of Peak Brain Institute and lectures at UCLA, teaching courses in psychology, neuroscience, and gerontology.
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Dr. Pompa:
Welcome to CellTV, Dr. Hill. Appreciate you being on.
Dr. Hill:
Thanks for having me, nice to be here.
Dr. Pompa:
Yeah, absolutely. We’ve had a lot of requests for this topic of neurofeedback. I think a few years ago most people haven’t even heard the word, right? It’s like now we’re getting all kinds of questions asking me—here’s what I get. Dr. Pompa, what do you know about neurofeedback? I said you know what? I get that question enough. I’m going to bring on one of the experts. You lecture at UCLA, and this is your field. You have PhD in Cognitive Neuroscience, so you know something about the topic.
Dr. Hill:
I do. I got my PhD studying how neurofeedback works. When I got into the field, I was pretty impressed by what it could do, but at the time, about 15, 20 years ago, there was different churches or schools of thought within neurofeedback. They had different functional approaches and different theories underpinning how they worked, and yet, they were all getting great results. I joke this is a blind men and elephant situation. We all had a piece of the truth, and no one really had the big perspective. This is why I went back to grad school and got a PhD.
Dr. Pompa:
Yeah, look, I mean, I think this can benefit everyone listening right now. Stay tuned because you’re going to realize that there’s some major conditions where this will really benefit you, but I really do believe we all can benefit. Start with your own story. I love to start there. How do you get into this? I mean, how’d you become an expert here?
Dr. Hill:
Sure, well, broadly, I’m a neuroscientist. I’m a cognitive neuroscientist, so I tend to do the mind-brain intersection. What I care about is, essentially, how the brain produces the human resources of mind, stress response, sleep management, attention management, all the high-level human resources that are to some extent combinations of different underpinnings, different physiological resources. A lot of attention is managed by inhibition, prefrontal. Hitting the brakes on your resources, so I wanted to understand how that all goes together. The neurofeedback stuff came up for me. I’d been working in health and human services for many, many years. I’ve always been somebody who wanted to understand what made people tick and machines tick and would dig into anything and try to understand all the mysteries around me. In working in health and human services for years, I discovered that we didn’t have a lot of the answers. I worked inpatient psych in a crisis environment and worked in dual diagnosis units and residential developmental disability houses. For years saw lots of services applied, but not a lot of change from those services, a lot of revolving doors in inpatient situations and chronic holding patterns for people who had developmental issues.
This is a little frustrating, so at some point, I left human services and went to high tech. Then the tech bubble corrected, and I, after a few years, left and went back into human services and went and worked in an autism center that used a lot of neurofeedback; a place in Providence, Rhode Island called The NeuroDevelopmental Center. I was shocked at what I was seeing. I was seeing symptoms lift, eye contact show up for some of these kids and adults. Sensory integration issues drop away, every so often language coming off where it hadn’t been present. Definitely all the other things that come along with developmental stuff getting addressed like seizure, sleep issues, anxiety. I was seeing all these actual change, and when I say change, I mean change in a matter of weeks and months. For ADHD, let’s say—I was seeing this back then. We still see it at our Peak Brain centers. We do 30 to 40 sessions typically for everyone to start the process of neurofeedback, and we get about 1 to 3 standard deviations of change in executive functions.
Dr. Pompa:
Stop right there. Let’s back up a second. I bet you most people have heard the word, but they really don’t know what it is. They definitely don’t know how it works, so walk us through that because you’re talking sessions and stuff.
Dr. Hill:
Yeah, sorry. Let me unpack that for you. Neurofeedback is a form of biofeedback. Biofeedback broadly is taking a physiologically nonconscious or not aware process, elevating it to the point where you can learn from it in some ways. Classic biofeedback from the 60s and 70s is hand warming. You stick a temperature probe to your finger, and you tie it to a pitch, and when your hand gets warmer, the pitch goes up in tone. You practice making the pitch climb. That’s a hand warming exercise. That’s used for headaches. It’s a form of biofeedback that’s classic for headaches.
Neurofeedback is somewhat similar in that you’re learning from the physiological signals, but you’re doing it from brainwaves or brain blood flow directly. Because of that, you aren’t tying into a signal in the body you can monitor and control like your breathing, or your heartbeat, or something. You’re tying into a very specific little brainwave parameter. Let’s say the amount of alpha waves, or the amount of theta waves, or delta waves, or how fast the wave is running, or connectivity between two regions, and so these are brain parameters you can measure in real time.
Dr. Pompa:
You’re connected to a machine, so you can watch it.
Dr. Hill:
Yeah, you stick a wire or two to your head, and you measure your brain in real time. Your brain shifts because that’s what it does. Things are fluctuating. When it happens to shift in the right direction, for half a second you go good job brain with audio and visual input. When the brain does the wrong thing or something else, you withhold the input. The brain goes, hey, wait a minute. I was watching that information. I think that was interesting. Where’d that go?
Then the brain happens to move in the right direction. The audio and visual presume, and the brain goes, ooh, interesting, and gets rewarded for having just done the shift it did. It’s an involuntary form of operant conditioning, essentially, shaping things up and down.
Dr. Pompa:
Yeah, I was just going to say similar to how I train my dogs. I mean, it’s very similar.
Dr. Hill:
Yeah, it’s the shaping. It’s Skinners pigeons. It’s not a Pavlovian thing. We aren’t making you salivate. I promise. We are taking resources that already exist, and we’re gently exercising them up or gently exercising them down by applauding the brain for certain things we think it might want to do more of.
Dr. Pompa:
Okay, so you gave us example of autistic children, ADHD. Walk us through. Okay, what are some of the other conditions that you see incredible results for, where it’s effective?
Dr. Hill:
Yeah, the low-hanging fruit for neurofeedback would include ADHD and broadly executive function, as you said earlier. Even if there isn’t anything wrong, you can usually boost these same resources, but for ADHD, the efficacy is extremely high. It works for almost everyone, and it usually eliminates ADHD in three or four months of time on the calendar. Also, very high efficacy for sleep issues, anxiety, and seizures, extremely high efficacy. The seizure is the average person has over 50% reduction and 5% of people have complete suppression of seizures for over a year. It’s a dramatic effect, and the field is discovered because it suppresses seizures.
Dr. Pompa:
Does it matter the causative factors of the seizures, or it seems to just…
Dr. Hill:
Great question.
Dr. Pompa:
Blanket over all the seizure conditions?
Dr. Hill:
It’s a great question. I don’t know is a short answer. I’m not sure anyone does. I would say the ideas about how it works would suggest it works broadly. The way we reduce seizure is by training up a frequency in the brain that neurologists call sleep spindles or sigma. Neurofeedback people call it SMR, sensorimotor rhythm. You’ve seen SMR if you’ve seen a cat lying in a windowsill, that liquid body but laser-like focus where the body—it’s the predator mode where the body is completely relaxed, preparing to spring, and the mind is locked into one stimulus or two stimuli. That’s the opposite of ADHD, by the way.
If you train up SMR in human brains, you raise the seizure threshold. Make the brain seizure resistant. You also add inhibitory tone to the frontal lobe. You get more self-control, and therefore, ADHD drops away. SMR is this rather magical frequency in neurofeedback.
Dr. Pompa:
A lot of the work that teach, we end up in a brain phase where we’re detoxing neurotoxins out of the brain, which create all these bad signals. Gosh, we can see now why this would be a perfect match for what I do. We’re up here getting rid of causative factors. You’re down here, basically, reprogramming how the brain fires and wires, I mean, pretty interesting.
Dr. Hill:
Yeah, so it’s just gentle exercise, and then you tell us if you—what you notice in terms of resources. Then we iterate and try something else. It’s like working with a personal trainer where you build a training machine together and see what happens, and then adjust it and continue.
Dr. Pompa:
Is there a way of looking at the brain pre and post? How do you measure that? I mean, symptom-wise is one thing subjective. What about objectively? How do we do that?
Dr. Hill:
Yeah, so I use two sets of measures for our clients. One is a map of your brain activity, which is stable year after year unless you do something to your brain, and the other is an attention test. It’s called the CPT, a continuous performance task. We use one called the IVA, usually. It’s pretty basic. For that test, we’re measuring your ability to sustain your focus and to not be impulsive under very boring conditions. We flash a number on the screen, and you click the mouse button when you see one number and not when you see another number, very, very unloaded resources. Then you make bored mistakes and impulsive mistakes. We see which kind of ways your attention frays under a very low load situation.
Dr. Pompa:
Can we see a difference on MRIs, cat scans of the brain before and after it?
Dr. Hill:
Not MRI so much, I mean maybe, FMRIs, sure but not MRI, structural MRI, unless you’re rebuilding tissue. Then that takes a lot longer than most of what we do. In terms of the other assessment, the physiological assessment, the brain mapping or the quantitative EEGs will be used for that. For that, we put a full head cap, like a swim cap, on your head. We spread it full of gel. We have you sit with eyes closed and open for about five minutes each, and then we take the resting baselines of your eyes closed and open brainwaves. Compare them to a normative database of several thousand people, and out of that, get statistical heat maps or Z-scores that show me how unusual your brain is in several thousand different parameters from the average person your age.
Some of those discriminants or phenotypes are valid diagnostically. Most are not. I can’t say, oh, this is true about you. I can say, oh, hey, this often—for instance, one of the most valid, the high ratio of theta to beta brainwaves. If your theta/beta ratio is elevated, that is the most valid marker that we can find for ADHD. It’s 95% or 94% accurate for blindly sorting ADHD and non-ADHD people into buckets simply on a brainwave parameter. It’s really quite robust.
Other things are not quite so robust. If I saw the anterior cingulate is extra active, more beta waves in somebody, I might say, oh, this often shows up when you sit there and ruminate or perseverate a touch. Do you get a song stuck in your head? Are you a little bit OCD? What’s going on? The person would usually say something like, oh, yeah, that happens to me, but it might not be OCD problem in the resource. It might be this person’s a high-powered CEO who uses that resource, and I’m seeing the activation of that switching circuit.
I can’t necessarily put it in terms of is it a good or bad thing, or which diagnostic label does it fit into? My job is to help people demystify which of the resources look elevated, or bottlenecked, or stuck. Then they help me understand which of those models I’m coming up with about their brain because most accurate and which thing they want to exercise. What they want to do with those resources once we figure out where the resource bottlenecks are.
Dr. Pompa:
That’s why I said it’s good for everybody. Obviously, it’s just like a muscle, right? We can all train the muscle what we want to activate, strength. That’s why I at the top of the show said, everyone listening, this could help you. You talked about autism, an exploding pandemic. What about Alzheimer’s and dementia? Have you noticed any improvements with that?
Dr. Hill:
I have not. I’m also a gerontologist. What I teach at UCLA is a course series in healthy brain aging and biological perspectives on diseases of aging. I’m pretty familiar with the state of the aging in gerontology research and biohacking around that. Neurofeedback is not your best bet there. Once you’re significantly symptomatic, you’ve lost a great deal of tissue, especially in the temporal lobes, and it’s really hard to rebuild that tissue unless it’s there.
That being said, there are—I used to teach this stuff, the gerontology courses, from the perspective of, well, dementia and Alzheimer, those sorts of things are progressive, degenerative, irreversible, and here’s what’s happening in the brain, students. It was a little bit of a depressing lecture as you may imagine or two. Now we include lots of discussion around the metabolic pathways that cause synaptic pruning versus synaptic density laid down. This is, basically, the work of [Dale Bredesen] showing that there’s metabolic factors driving synaptoblastic versus synaptoclastic processes. The same way those processes balance in bone density in the body. If you take statins, you throw off your bone density, and you lose density because of the osteoclast-osteoblast imbalance. It turns out there’s some evidence that Alzheimer’s and other forms of dementia may be an imbalance of the synaptoclastic and synaptoblastic, that balance that deposits or prunes stuff in the brain. Dale Bredesen found 37 metabolic factors where if a certain—enough of them get out of range, the system seems to prune towards losing tissues in those resources that we think of dementia drivers.
Dr. Pompa:
Yeah, no, there’s more and more studies showing why certain neurotoxins drive—what you’re talking about is an upstream cause of that process that you just described so well. People learn from the stories, right? What are some amazing stories you have seen with this because I know there’s a lot. I’ve read some of them.
Dr. Hill:
Yeah, I mean, I’ve seen some amazing things. One thing isn’t necessarily starting off on a good note, but I had a client come in. A mother brought her 8-year-old son in, and he crawled into the office, and crawled under the desk. He was high pitched, whining, and there was no eye contact. It was pretty obvious he was on the spectrum. He’s autistic of some sort. According to the mom, six months prior, he had been relatively high functioning, making eye contact, and speaking. Now, sometimes kids developing autism do lose language, but it happens around age 1 or 2, not later. As language shows up, it goes away, so it was very unusual this happened.
It turns out she had done a brain map, got some neurofeedback protocols. Actually, no, it wasn’t a brain map, just some neurofeedback protocols and some equipment. Went off and trained her son without any supervision for I think 45 sessions of training, which is a fair amount of training, and he progressively got worse in language and sensory things the whole time. In retrospect, it was because the protocol wasn’t’ right for him, but she didn’t know that. She thought, oh, this is neurofeedback. It’s good for him. Let me just keep going, and he regressed back to where he had been at age 2, before years of very intense work. She came in, of course, in tears. What’s happening with my son?
We reassessed and some very careful work with him. Over a few months, he developed—he regained all of his skills, and he continued to thrive. We set the mom up with her own system at home again and were supervising her use of it. That kid graduated valedictorian of his small liberal arts college in the northeast a couple years ago.
Dr. Pompa:
What was the reason for regression? You answered another one of my questions. Are there negative or drawbacks to this?
Dr. Hill:
Yeah, usually, the answer is no. If I train you the wrong way—let’s say I’m training you for sleep onset. I have protocols that help you turn on the sleep reflex when it’s time to go to bed. If I’m training you for sleep onset and you feel pretty good in the office, and then you leave, and instead of getting better sleep onset, you’re wired, and you can’t fall asleep. Normally, you come back in and say, oh, that protocol didn’t quite work. That’s useful, and it wears off the next day. It’s conditioning, so it pushes you off in this direction. Unless you keep pushing it, you swing back to where you were, so you can use gentle side effects, if you will, as informative, right? If you ignore side effects, they get stronger and stronger and stronger, and before you know it, you’ve created a more permanent resource as a side effect as opposed to the resource you’re looking for.
Dr. Pompa:
Right, so okay, you answered the question. You better do this with somebody that knows what the heck’s going on, right? It’s like detox, right? It’s like people keep pushing in times when they shouldn’t, probably not pushing when times that they should, and they end up worse so very similar, I would say. That’s why I train doctors to do the work that I do. Where do they go to get this? I mean, people right now are going, okay, I think I need this, or my child needs it. Where do I go?
Dr. Hill:
Most people in the north—sorry, in North America, in these two continents here, are therapists. There’s about 5,000 people in North America, about 10,000 worldwide that do neurofeedback, and the vast majority of them are therapists. That’s one of the things we’re doing differently at Peak Brain is we’re trying to create a network of brain gyms. While I happen to have a PhD, I’m not your doctor in this role. I’m really the coach of a big program, and my technicians are your personal trainers. They’re there to develop the relationships, understand your goals, help with data tracking, help deliver the techniques the right way. Then I’m -inaudible- 10,000—watching your brainwave data come in and talking on the phone and making treatment plans and things. Peak Brain has several offices. We have five open throughout the US, and we’re opening several in Europe.
Dr. Pompa:
How do you find?
Dr. Hill:
I’m sorry?
Dr. Pompa:
Just google Peak Brain?
Dr. Hill:
Yeah, Peak Brain Institute, we have peakbraininstitute.com, and we have our five locations there. Then we also work a lot with people remotely, so if you want to work with us and you’re not near one of our office, you can come to one of the larger offices for three days, get a brain map, learn how to do neurofeedback on yourself, leave with equipment, and for three months, we do live chat support, weekly calls. Do a shared shard, and help you learn to do your own protocols. It can get you just about the same effects you would get by coming into an office for a few months.
Dr. Pompa:
Can they lease the equipment? How does that work?
Dr. Hill:
I used to lease equipment, and then no one ever wanted to give it back.
Dr. Pompa:
How much is it?
Dr. Hill:
They all buy it, typically, yeah. The way I do it, equipment doesn’t expire, so it’s just getting them set up with their own hardware. Most of my clients, they’re home trainers or either peak performers who are training for a long time, or they have brain injuries, which take longer to work on than ADHD, or anxiety, or something, or they have a bunch of people in their family or friends they want to share with. It becomes cost effective because the equipment’s a one-time purchase, and then we do the supervision period. We also at Peak Brain provide brain mapping for our clients. After the first time that you do mapping, there’s no charge. If clients of ours out in the world have equipment, we’ve done a few months of training, instruction. They often address most of their big needs in that time, but we expect they’re going to want to check on their brain again, get some protocols, keep training. We provide the soft support, data access if you will, without charge long term for clients too.
Dr. Pompa:
That’s great, yeah, so it’s pretty accessible. I mean, like you said, you made it available, yeah, to anybody.
Dr. Hill:
Trying to, yeah.
Dr. Pompa:
Yeah, exactly.
Dr. Hill:
It only works if you have a brain, though.
Dr. Pompa:
Therein lies part of the problem, I think.
Dr. Hill:
Right, it’s checking the head, yeah.
Dr. Pompa:
Oh, man, okay, so that’s one way. Are there other ways to engage brain health? I mean, you’re a neuroscience man.
Dr. Hill:
Sure, lots of ways, yeah.
Dr. Pompa:
You have a lot of things. Give us some other ways.
Dr. Hill:
I would say there’s a handful of top foundational ways to address brain health. Some of those are really easy and accessible. Some are a little more esoteric or technical. Neurofeedback’s very high tech, and none of them can reach out and just administer it, so to speak. The other end of the spectrum is mindfulness or meditation. You’re carrying around the equipment with you to do it all the time, I hope, and it’s a basic set of practices. I mean, most people when I teach meditation think that it’s getting to a place of stillness or a blank mind, and they get very, very concerned they can’t do that. I have to spend a lot of…
Dr. Pompa:
ADHD people, ADD people, it’s like—I can’t meditate. I can’t even sit for a second, and yet, maybe need the most.
Dr. Hill:
Yeah, exactly, you need it the most, and meditation is not the act of getting to a still mind. Just like going to the gym isn’t the act of being strong. It’s the act of lifting weights. For mindfulness or meditation, sitting in—it’s an anchoring of your attention, your executive function in some way. To use Jack Kornfield’s definition, mindfulness is paying attention in a specific way on purpose to the present moment and that I’ll add with curiosity instead of evaluation, if you can. It’s about anchoring your attention in some specific way.
Then when you notice your attention has drifted—because guess what? You have a mind, and you think, dream, wish, plan. Your knee hurts. She’s cute. I’m hungry, whatever it is. When you notice you drift away from the anchor, the anchor of your attention, you let it go, and go back to the anchor. That’s essentially one rep of your meditation. If you’re really ADHD or distracted, you have lots of opportunity to go, oh, I’m thinking, back to the anchor. Ooh, I’m planning, back to the anchor. Oh, my knee hurts. Not right now, back to the anchor, and you’re doing meditation even if you’re not still.
Dr. Pompa:
If you were teaching me to meditate that way and have mindfulness, if you will, where would you start with me?
Dr. Hill:
I would simply have you find something you don’t find too annoying to pay attention to. I typically start with a couple of basic techniques, single point awareness and present time awareness as some complimentary practices. For present time awareness, which classically in the history books you would call Samatha, I have people watch the sensation of air crossing the philtrum, the little divot under your nose. You breathe in and out. You simply watch that one point, and try to pack your attention down into only noticing that one point of stimulus.
Dr. Pompa:
You’re saying watch it. You can’t watch air. You’re saying visualize it as you’re…
Dr. Hill:
Put your attention on the sensation of air crossing that spot of skin and try to…
Dr. Pompa:
As you’re breathing.
Dr. Hill:
As you’re breathing in and out, naturally breathing in and out, allow your breath to have it—do whatever it wants to do, and pay attention to the sensation of breath at that one spot. The point here is to become single pointed, to pack your attention down. Then within a few moments, you’ve drifted, and so you’ve practiced laying back, going back again and again and again. I have people do that for five minutes.
Dr. Pompa:
You said, okay, here I am. I’m doing it. Okay, in 30 seconds, my mind just starts thinking of my kids, right? Okay, then I’m back to it. Okay, now, I’m picturing that. Okay, that was one rep. Okay, now I’m doing it maybe ten seconds. I just thought of my wife. Okay, there’s another rep. Is that what you—how many of those do you do?
Dr. Hill:
Now, you can count reps, but I suggest, if you’re going to do that, there’s another technique. What I suggest for basic practice is do 5 minutes of single point awareness, and then 15 minutes of present time awareness. That’s 20 minute practice. If that sounds daunting, cut it in half. Do two and a half minutes of what you just described, watching the sensation. Then do seven and a half minutes of a different practice, and for that one, watch something rhythmic like the breath in and out of your body, watching it. Pay attention to the sensation of breath coming in and out of your body, or maybe listen to cars coming down the street, getting closer and closer and then going far and far away. Practice anchoring the sensation of the change, watching the process instead of the point.
Again, within a few moments, your mind’s drifted. Your knee hurts. She’s cute, whatever, but it’s a different type of anchoring. Now it’s anchoring to a flowing thing as opposed to a single point.
Dr. Pompa:
One was present. What are the two called?
Dr. Hill:
Sorry, single point awareness followed by present time awareness.
Dr. Pompa:
Okay, yeah, single point and then present…
Dr. Hill:
Present time.
Dr. Pompa:
Present time is what a car—you said going back and forth.
Dr. Hill:
Yeah, most people, breath is the classic one. When I’m sitting by the street, I can hear cars. Close my eyes, and listen for a specific engine sound, or specific truck, or something far, far away. Then hold my attention on as it gets closer, and watch the quality of the sound getting louder as it gets by my house, or as it goes away, watch it go away. I’m going to hold my attention onto that one discreet stimulus until I can’t notice it anymore. Then I pick another stimulus out further down the street, and do it again. It’s the same thing as your breath. Just not as boring.
Dr. Pompa:
What does this do for the brain, and what does this one do for the present time versus -inaudible-? What do they do for the brain?
Dr. Hill:
Great question. Broadly, all forms of meditation build inhibitory tone. A lot of human resource is driven, is enabled by the ability to say no. I’m not going to eat this, fight with that, spend this, and that’s a really human resource. The prefrontal cortex is the most human, if you will, part of the brain. It’s the part that’s most unique to us, and a lot of its job is inhibitory, and it’s the brakes. I mean, would you rather go down the mountain on a mountain bike with or without brakes? Will you get to the bottom faster with or without brakes? It’s going to be a—having control is really important.
Dr. Pompa:
You would actually get there faster with brakes.
Dr. Hill:
Exactly, you have control, exactly, and so without the control, without the brakes, executive function is very reactive. We get ADHD. We have emotional reactivity. If you would learn to anchor repetitively, the single point awareness especially builds that prefrontal tone that inhibits our ability, ability to pump the brakes in a thought, an emotion, an idea. More importantly, your working memory, the space within which you think, the scratchpad of your mind where you experience everything, that is about five to nine items is the human range, and when the tenth item comes in, stuff gets kicked out. The better you are at protecting what’s coming in and out of your mental scratchpad, the better you are at thinking.
You can have a working memory of seven items, but your ironclad control about what you’re thinking about, that’s inhibitory tone; deciding what gets in there, which memory pops up, what thing you’re seeing in the environment gets registered. You can resist that if you have good inhibitory tone and lock stuff into your mind, hold concepts up, throw words around, and have just what you want come out in behavior and action. Single point awareness brings the inhibitory tone up. Present time awareness brings the sustained ability to do that.
Dr. Pompa:
All right, so sustained versus inhibitory. Okay, yeah, my wife’s going to kill me here, but I have to do it. As I look at the two of us, we’re very, very different, right? She, I mean, pops here, pops there. Pops it to the point where I’m always bringing her back to a certain point, and there’s open circles everywhere. I’m bringing her back in conversation. You left an open circle up there. Meaning there’s a topic, and you moved onto another one. We still didn’t finish that topic.
I am the exact opposite. I’m laser focused and have almost an inability to think of too many things. Is there genetic components to this? Is it some people are just more gifted at this, other people who aren’t? Are there positives to being the other way versus the other? I don’t even know what I just asked.
Dr. Hill:
No, I think I understand. Let me see if I—I’ll take a crack at it. Broadly, my perspective in the brain and genetics and this is true of resources in general, also true of aging, about a third, maybe 35% of your experience is genetically bound. What I mean by that is most things that are genetic are not Mendelian, dominant recessive, where you have two copies of a gene and whatever wins out in that math ends up being what’s expressed. That’s not how most things work. Most traits are encoded for by thousands of proteins. It’s like a river. Way upstream, different genes are doing different things that accumulate effects to produce what’s happening in the body.
Dr. Pompa:
You’re talking about epigenetics here.
Dr. Hill:
Yeah, the environment changing what’s expressed but also the accumulation of thousands of genes producing one trait so that subtle differences in the genes don’t have dramatic differences in the trait, generally. The genes are a tendency to do something in the resources as opposed to a hard thing.
Dr. Pompa:
No different than any disease process. I mean, there are some genetic—like you said, some actually hardcore genetic things, but most of it’s not that at all. Most of it’s things that get triggered in susceptibility.
Dr. Hill:
Exactly, and so there are some benefits for having a mind that is novelty seeking, synthetic, pattern matching, and go squirrel like your wife or being blinders on, heads down. I can ignore the environment, very, very hyperfocused, perhaps like you. This is essentially hunters versus gatherers. You have the ability to sit and focus on a plant and go that’s a weed. That’s not. This is important. Here are some nice records. The sun’s coming up three hours earlier, pretty late in the summer, so we should plant earlier. You have the brain that can very carefully organize on low stimulus details.
Your wife is looking for the high stimulus and is cued by the environment. Some people have the ability to move back and forth between those states pretty well but often can’t go to either extreme. Some people are at an extreme but stuck there. When you’re stuck deeper where your wife is, they called it ADHD, but it’s a super power when it’s lined up with the environment. I mean, any ADHD kid in the world can play videogames for 25 hours straight without a break in a way that is supranormal. It is beyond typical by far. That same kid can’t find focus 20 minutes in a classroom. Why not? He has the resource. He’s relying on the environment, the stimulus, the high valence, the high stimulus stuff to drive it, so things need to be threatening, sexy, dangerous, yummy, something to engage that resource.
In the concept of neurofeedback, I would look at somebody with a high stimulus driven ADHD brain and probably find high theta. They’re very reactive. It’s a stuck state, so I would then gently train it down over time. At the end of that time, they wouldn’t have stuck theta, so they can bring the focus resources on at will. It feels effortless. It doesn’t feel like it’s an engaged problem. Here’s the nice thing; when you then sit down to play videogames again or do your high stimulus thing you need to do, you bring the ADHD back, and it’s still there. The resources don’t go away. You get control over them, so you don’t have to be an ADHD in the boardroom or the classroom. You can be in front of the easel, or the typewriter, or whatever it is you want to do to be that synthetic, highly tied together individual.
Dr. Pompa:
Yeah, you’re right. I mean, these ADHD people, I mean, they are amazing at running companies. I mean, there’s some really amazing gifts, but again, it could be very destructive. With the neurofeedback, you can absolutely channel it, man, and bring out the gift of all. I love that.
Dr. Hill:
You can decide what you want to work on. It’s very cosmetic in that way. Ooh, I’m a bit too impulsive, or I’m a bit too easily traumatized by relationships. Let me dial down the sensitivity, the circuits, and get a little more resilience in my attention resources, stress response. People choose what they want, which for me, the enabling of agency, this is why I do Peak Brain. It’s why we’re doing it the way we’re doing it. I saw how mental health and human services do the human cattle thing where they take—where once you’re in the systems, it’s hard for clients and patients to have agency. Especially in residential, long-term, and severe cases, it’s hard for people to have agency when nothing—when no interventions do a whole lot.
I’m trying to take, oh, it’s anxiety, or ADHD, or a seizure? Oh, that’s just your brain. The same way it’s, oh, it’s just your shoulder, or your abs, or your knee problem. Great, what do you want to do about that? A, we can look at it. It’s no longer mysterious because it’s just your impulsivity, or your brain injury, your slowed processing speed, your aging, whatever it is. We can help you demystify it, so it’s not quite so scary. Then it’s not your fault if it’s your brain.
Then, B, you can take control of it and decide what you want to do. This is really why we have this mission is to say, oh, you don’t like what your brain does? Okay, what do you want to do about it? Your brain is a more changeable organ than anything else in your body.
Dr. Pompa:
That’s the good message, and like you said, the neurofeedback’s the fast track there. You have the mindfulness in the mediation exercises you gave us. Right now, I think more popular than ever are certain supplements and drugs called nootropics, which is something, a supplemental, if you will, or a drug that focuses on the brain in giving you better brain function, clarity. I mean, come on, caffeine’s a nootropic, if you will. Talk a little bit about that as possible solutions.
Dr. Hill:
I think there’s lots of good stuff there. I think that it can be very difficult for people who are new to brain science or to nutrition or something to really navigate a bit of a Wild West of brain supplements and nootropics. I would draw people’s attention to the fact that nootropics strictly speaking, as the original definition, include things that promote brain health, memory, attention, language. Protect against damage or disease, and they do so without appreciable side effects.
The modern category of nootropics as a marketing and branding tool includes things like modafinil and Adderall, and it doesn’t really fit the original category. People are distorting the word nootropic.
Dr. Pompa:
-inaudible- of damage.
Dr. Hill:
Even caffeine has some side effects. It’s habit forming and some other—it doesn’t, from my perspective, strictly fit. The reason I’m being—I’m harping on this is because I think—especially if you’re a high performer. A lot of high performers without really big deficits go after nootropics. Try to squeeze out a little more performance. I think if you’re already a high performer, your tolerance for side effects risk should be very, very low, and you should only go after things that really boost you without too much side effect.
I’m a fan of encouraging people to go after the true nootropics, if you will, supplements, natural ingredients, amino acids that generally don’t have a lot of downside as opposed to going after the more cognitive enhancing smart drugs and other things, prescription things that I think often do have some downside. I would put a bunch of things in the true nootropic category like L-tyrosine, which is a precursor to dopamine, or acetyl-L-carnitine, which is used by mitochondria for cellular fuel, or L-theanine, amino acid found in tea that buffers caffeine. It’s GABAergic. It’s very calming. If you like caffeine—and believe me, I love caffeine. It’s usually quite good for your brain. If you’re a little sensitive to it, you can add some L-theanine to your coffee habit, and suddenly dial in the smooth push. Your coffee treats you like tea instead of coffee.
You don’t have to go crazy with nootropic substances to get a nice effect. You can do one or two small innocuous, low-key things, and you should because these things are often are synergistic. You can get polypharmacy with supplements as easily as you can with prescription drugs sometimes. It’s really important to be a little strategic, slow, cautious.
Dr. Pompa:
What about some people are—now it’s in vogue, the micro-dosing. Whether it’s micro-dosing of mushrooms or things that would normally be definitely damaging, they micro-dose and say it’s a nootropic. Is there truth to that?
Dr. Hill:
It’s a great question. The short answer is I don’t know. The longer answer is I have a hunch that most of these micro-dosing phenomena—and I do think they’re doing something. I think most of the micro-dosing phenomena are irritating the brain into plasticity, and that’s the primary effect. I don’t think it—I don’t think and I could be wrong, but my read on it at this point is that it doesn’t—it’s not so much about the serotonergic effects of psilocybin, or the LSD, or the MDMA, whatever it is—or the cannabis, whatever people are micro-dosing. I don’t think it’s about the substance per se. If you monkey with one of the big neurotransmitter systems, you get downstream upregulation of trophic factors, plasticity factors like BDNF. In fact, SSRIs do this. The way the SSRIs actually produce a true deep lift of depression is by causing plasticity in the hippocampus through a BDNF regulation that’s quite a bit downstream from the serotonin reuptake inhibition at the serotonergic neuron, but the mood effects aren’t actually, from my perspective, not directly serotonergic. Some stress and anxiety things may be, but the mood things are more about hippocampal plasticity and BDNF.
I have a hunch that there’s some slight dopaminergic effect from these psychoactive substances. People feel them a tiny bit and feel interest, and they motivate a touch. They’re more engaged with their environment through—it’s like dopaminergic effect, and beyond that, it’s plasticity boosting. I don’t really care what you do to your brain to boost plasticity. Do something, meditate. Do neurofeedback, exercise. Do some good nootropics. Do Sudoku or whatever it is, but do something to cause plasticity and maintain it and even enhance it. If those things are controlled substances that may have some downsides and may have differences across individuals, my concern with those things would not be so much about the purported benefits and how they should work with people. It’s the fact that they’re controlled substances that are on a gray market or black market, and you might end up with something you don’t expect.
That’s the problem, nootropics too. You buy lots of stuff, white powders from random countries, and it shows up with improperly synthesized compounds and heavy metals. That’s in things that are supplements that are supposed to be good. Now you’re talking about psilocybin or MDMA on a black market website or something. I think it’s very risky, and I’m a little bit—I think it’s foolish, and people that are trying to go after cognitive enhancement are smart enough to know better.
Dr. Pompa:
Yeah, so we just spoke to a small group of people even know what those things are and are looking for them. Let’s go to the other end of the spectrum. My children tell me all the time, dad, all of our friends utilize Adderall, whatever the other names of them are. It used to Ritalin. It went to Adderall, and now there’s some new ones. I mean, they use them just to focus, to study. I watched a special on it. They said, really, you think you’re able to focus more, but at the end of the day, the test scores were no different. I mean, tell us about those things.
Dr. Hill:
I mean, stimulants do work to add some focus and add some inhibition. They don’t work all that well. It’s not just about the attention control so a couple things. One, I think that it may be worth considering psychostimulants if your behavior is profoundly dysregulated, and you can’t deal with your classroom, your boardroom, whatever it is. You’re so ADHD that you can’t control any of your behavior. It may make sense. For everybody else, you can get control of it with other things. You probably should.
Adderall and Ritalin and methylphenidate and all the other brand names of the second stimulants, second-class stimulants like Vyvanse and things, the problem with those is not so much if they’re effective or not. They can be, but they aren’t, as you say, super effective. The problem is, if you look at kids that are put on those drugs, they have self-esteem issues later on about their cognitive performance. It doesn’t improve academic performance as a drug supplement, and it does impair the social cognitive neuroscience, the understanding of your own brain, your own resources. These kids don’t learn to structure their time, not procrastinate, engage with low stimulus tasks without frustration, and those are the things a stimulant actually should be scaffolding for them. Adults tell me all the time they take stimulants and spend a lot of time heavily focused on Fortnite, or porn, or something else they don’t necessarily want to focus on.
You mentioned the kids are taking the stuff, and your kids mentioned their peers are, and this is rampant. It’s also rampant that parents are taking their kid’s Adderall to function during the day at work. There’s a fairly large stimulant—not all that silent but stimulant abuse problem in this country. ADHD is over diagnosed. From my perspective, it should only be diagnosed when it’s a significant impairment in multiple aspects of life. I think we’re all armchair psychologists. When we see an impulsive or a fidgety kid, we go, oh, ADHD, and then the kid gets Adderall. Some of these drugs do actually produce behavior change, but maybe it’s a sleep issue, or maybe it’s trauma, or maybe it’s something else that produces the same kind of dysregulated behavior in a kid, and stimulants might just mask some things and cause more problems in the future.
Dr. Pompa:
Yeah, and one of the problems, doc, is we know that, just like any other drug, often times you need more of the drug to get the same response, or you end up on stronger drugs. In this case, you can use street drugs.
Dr. Hill:
Yeah, with stimulants, you feel them, and so you’re teaching kids essentially how to take control of their difficult resources with an external locus of control. It’s coming at you. Studies show that it doesn’t produce any improvements later in life in self-esteem or ability to structure time. It’s a Band-Aid sometimes on the most destructive behavior in the classroom without really any support of the person. I think it should only be really medicated when it’s really quite extreme, and somebody has disruptions in more than one area of their life, school and home and work. There are some cases where it’s quite poor in terms of self-control with ADHD, but the vast majority of cases, people are—most of us are armchair psychologists. We’ll see a fidgety kid or impulsive person, and think that it’s ADHD. Suddenly there’s stimulants onboard, and without digging more deeply in, we don’t know if it’s a sleep issue, or some trauma, or some anxiety, or other things that produce distractibility or inattention.
Stimulants can make all other things like that worse. Then ADHD, even if it truly is ADHD, often comes along with a sleep issue and some anxiety and some other things, and so the stimulants will exacerbate some of the problems while maybe addressing some of the other problems. It’s an imperfect situation, and worse than that, I think it takes the agency away from the kid. Something’s wrong with you. Here’s a pill to make—to fix you. While the pill’s active, you’re okay. When the pill’s not active, you’re a problem.
Dr. Pompa:
Yeah, I mean, that’s why it’s a shame because you have something like neurofeedback that’s so available today, so effective. We’ll make the resources—we’ll put them in the show notes and how people can find this resource. I mean, it’s beyond ADHD. I mean, there’s so many conditions this benefits, as you mentioned. Name you would say the top five conditions that you would say, absolutely, you need to do neurofeedback.
Dr. Hill:
Things that it works better—neurofeedback works better for, the first line, I would say, intervention would include ADHD, anxiety, sleep issues, seizures, migraines, PTSD, OCD, concussion, post-concussion stuff, sleep issues, slow speed of processing with age that produces word finding issues and sluggish processing when you’re older, creativity, T-cells, boosting your T-cells in your body. Those are just the things where there’s decent research support. Those are the high points. It works on lots of things, obviously.
Dr. Pompa:
Yeah, that’s pretty incredible. Wow! Okay, last question, I think it’s the most important of all. What’s going on with the guitar collection behind you? How does that fit in there?
Dr. Hill:
Actually, over my shoulder, those are mandocellos. Those are eight string; tune in fifths like a cello, the size of a guitar. They’re electric cellos, basically. I have quite a collection for quirky instruments, and I designed a couple of those. They’re a left hand and right hand version of the same instrument. I’m left handed, and I play both ways. I tend to design and muck around with quirky instruments whenever possible.
Dr. Pompa:
Wow! There you go. Yeah, it’s probably something to do with your interest in the brain. He’s left -inaudible- ambidextrous, oh, my gosh, if I could only hear about your childhood. Hey, well, listen, Dr. Hill, thanks for being on, a wealth of knowledge in this area. This show is going to affect a lot of people. I can’t tell you…
Dr. Hill:
Thank you, Dr. Pompa. Oh, I appreciate it. Thank you for having me. I really had a great time chatting.
Dr. Pompa:
We’ll make sure your resources are put here in the show notes, so thanks again for being here.
Dr. Hill:
My pleasure, thank you.
Ashley:
That’s it for this week. We hope you enjoyed today’s episode. This show is brought to you by CytoDetox. Please check it out at buycytonow.com. We’ll be back next week and every Friday at 10 a.m. Eastern. We truly appreciate your support. You can always find us at podcast.drpompa.com. Please remember to spread the love by liking, subscribing, giving an iTunes review, and sharing the show with anyone you think may benefit from the information heard here, and as always, thanks for listening.
