Episode 20: Dr. David Hagedorn on Using Brain Mapping for Anxiety, Depression, and PTSD
Show Summary:
Dr. Hagedorn is a clinical health psychology and neuropsychology expert and a recognized leader in the clinical neuroscience field. As an international speaker and instructor for advanced psycho-neuro electrophysiology assessments and interventions, Dave has a specialized skill set in working with patients with traumatic brain injury, PTSD, ADHD, anxiety, depression, and much more.
Join us for a conversation about the root causes of conditions such as depression, anxiety, PTSD and ADHD and what you can do to support your brain health.
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Full Episode Transcript:
SPEAKERS: Dr. Andrew Wong, Dr. David Hagedorn
Welcome to the Capital Integrative Health podcast, a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. I am Dr. Andrew Wong, co-founder of Capital Integrative Health, an integrative practice committed to expanding access to holistic root cause medicine to the global community.
Today, we are bringing you a conversation with Dr. David Hagedorn. Dr. Hagedorn is a clinical health psychologist and neuropsychology expert and a recognized leader in the clinical neuroscience field. As an international speaker and instructor for advanced psychoneuroelectrophysiology assessment and interventions, David has a specialized skill set in working with patients with anxiety, depression, PTSD, ADHD, and much more. Join us today for conversation about the root causes of conditions such as anxiety, depression, ADHD, and PTSD and what you can do to support your brain health.
Dr. Wong:
Alright. Well, welcome Dr. David Hagedorn to the podcast today and we're so glad to have you here with us.
Dr. Hagedorn:
Pleasure to be here. Nice to talk to you.
Dr. Wong:
And Dr. Hagedorn, you are an internationally known expert in clinical psychology and neuropsychology so we just wanted to kind of start broadly first, what made you first interested in this field?
Dr. Hagedorn:
Sure. So, I was doing a lot of neuropsychological testing with patients in Dallas and parts of Oklahoma and it became apparent that after an eight-hour test battery in a 12-15 page report, all I was able to do is tell the patient their head was not working correctly, something they knew before they walked in and to charge two thousand dollars to tell them that but not really have a good treatment plan other than you know, get cognitive therapy, go see your primary care doctor. Tt was embarrassing, frankly. I mean I could articulate the problems with testing but I had no solutions and I started adding EEG analysis to my neuropsychological testing at some point and I realized that in 30-45 minutes of data collection, I knew more about the brain function than in eight hours of neuropsychological testing and I knew how abnormal each area was and I knew what symptoms they would have so I could predict their symptoms just with the data from the brain so the best part was it actually gave me targets, targets to treat with neurofeedback, with brain stimulation, with selective use of medications, with treating underlying mechanisms like enteric nervous system problems so it became apparent that that was most useful and then the Department of the Navy, through a large contract company, hired me to come teach neuroscience at Camp Lejeune in residency program so I became an adjunct faculty for the military medical school you know, staff with the hospital for teaching the residency and we brought this concept to the Navy yet the testing would still take you know, 45 minutes. You would have to take a half hour, 45 minutes to analyze the data and while it was tremendously useful with military members coming back from Fallujah with blast injury and PTSD, it still wasn't smooth enough, fast enough, automated enough to make it go to a clinical level. It was still you know, a lab level tool and we decided that we got to make a better mousetrap, something that would be faster, easier, automated kind of idiot proof frankly and that was the genesis of the company and I got a little bit of money from an investor out of the country and that launched Evoke.
Dr. Wong:
Right. So, thank you for that answer, Dr. Hagedorn. For those that do not know, Dr. David Hagedorn is the founder of the Evoke Neuroscience Company which I believe you founded in 2009, is that correct?
Dr. Hagedorn:
Yes.
Dr. Wong:
And let's talk about that for a sec. So the Evoke brain mapping, what is the Evoke test? What are some of the features of that test?
Dr. Hagedorn:
Right. So, there is no such thing as really the Evoke test, spokes a company, but EEG analysis using quantitative methods is used worldwide and it's been used for over 20 years worldwide and validated worldwide so Evoke didn’t create a unique test. All we did was make it more efficient, easier, and automated. So you are doing a 19 channel EEG, a three channel ECG for looking at the heart and with that data, we're able to collect heart rate variability data, we're able to record all areas of the brain, we're able to look at what's called Evoke potentials which is processing speed in under certain conditions that the brain is put through so all these tests have been in existence for decades but they've all been in labs and in research papers and because it wasn't easy enough to put it in a clinic so all Evoke did was take existing proven technology, simplify it, automate it, and distribute it to clinicians that would then have another tool in their toolbox.
Dr. Wong:
Now just to be clear, what is the difference between a quantitative EEG and a standard EEG that you might see from the neurology office?
Dr. Hagedorn:
Great question and it's a routine EEG so in a routine EEG, you look at you know, typically 19 channels, sometimes more, very infrequently less than that and you'll record it and you're looking for morphology. Morphology is the shape of the wave and you're looking for certain features in the way of like spikes, certain abnormal features which tell you have cortical abnormality. Most EEG reports are dictated in 30 seconds. A person looks at the data very quickly and they dictate the report and that's useful but they almost always say normal even though the brain is not normal, the patient's got tons of symptoms, the routine EEG will say normal findings. It'll say you know, maybe a sleepy pattern, maybe it'll say some artifact, it'll tell you about their alpha rhythm but for the most part, they say normal when you're like why did they even order this because they keep coming back normal and I know the patient's brain is far from normal. Quantitative EEG is also just as valuable in combination with a routine EEG but what you do is you take that person's EEG you compare it to a normal reference group by age and gender and then you take each frequency and you dissect each frequency out of the squiggly lines and then you plot that in pictures and images and you can show difference from normal across all areas of the brain. For example if you've got frontotemporal dementia, typically you'll have frontal temporal slow EEG excessively. You'll be able to see that very clearly in a picture. A competent reviewer of EEG can see it in the morphology routine EEG as well. It's just easier to see it and put Z-scores to it when it's done quantitatively and the other advantage is you can use something called LORETA. LORETA source localizes that abnormal EEG to what structure in the brain it's generated from so for example, if you have an excess amount of high alpha say 13 hertz or 12 hertz coming from the cuneus, you can see the generator from the cuneus. We typically see that pattern when this person's got a stress disorder like PTSD for example and that would start to give you an idea about what brain region is involved for example and it helps you then target your neurofeedback treatment deliberately and individually for that person.
Dr. Wong:
Great. Thank you so much and let's still start broad with another question about you know, I think people that are listening here may have already done EEG or some have not but who should be doing a quantitative EEG? Who would you consider as a clinician, as an educator of course in this, who would you consider for a quantitative EEG?
Dr. Hagedorn:
I think it's appropriate at the primary care level. I mean we know neurologists use it around the country, around the world and it expands their capability greatly so certainly Neurology is a great specialty group to do more QEEG analysis as an addition to the routine EEG because this is a seated at rest condition, a sleepy pattern as well with the eyes closed but it doesn't replace necessarily you know, a routine EEG. It's nice to do both but really people are coming in with brain problems and it's a low-cost, non-invasive approach to get an idea what's going on with them to help you make a better referral so I really believe Internal Medicine, Primary Care, Family medicine are really the first stop for looking at the entire body because before you send them off to a specialist, it's really incumbent upon the clinician to have looked at every system of the body and what's causing this. Is it hormone related? Is it low testosterone causing low power in the brain? Then you see that in the brain, you say well you know, let's run a free t, let's run a total, let's look at an estrone level and see do we have a power issue in this cell that I can remedy very quickly in my office before I'm shipping them off to Neurology for cognitive impairment so it's a wise in my view to start with low cost, powerful, least intrusive testing before you move them up the chain to specialists.
Dr. Wong:
Primary care is often the first stop for people in their health care journey and one of the things that we know is that mental health is severely under-treated and under-diagnosed, right? So, we have a lot of lab work for physical health things. You know, we check high cholesterol for high cholesterol and screen for high blood sugar and diabetes and things like that but how do we screen for mental health issues besides someone saying, “Hey maybe I have anxiety or depression or brain fog”, or things like that and one of the things that I've noticed is that the quantitative EEG really helps to uncover and even validate mental health conditions and really put it on equal footing with those physical health conditions because we all know that both of these you know, mental and physical health are equally important here.
Dr. Hagedorn:
Yeah. A good analogy really is the you know, the EEG and quantitative analysis that we you know, loosely call it the brain mapping as this you know, a term that is thrown around. It's like a lab test for the brain when we really didn't have something like that for many many years. You know, people walk around with hypertension and hyper cholesterol, they have no idea. They don't even know that their thyroid's off until you test it and then it's like wow, I can see it it's validated, it's real, it becomes a target for treatment and if you do things early and look at things early, there's things you can do about it and turn the ship around the earlier you start so I really find it incredibly valuable as an introductory assessment for patients to start to look at what's going on in the brain housing group, what's going on up there early rather than later.
Dr. Wong:
What are some of the mental health conditions that the brain mapping we would say can help to uncover?
Dr. Hagedorn:
Well, we just start with the most acute and more recent problems we're seeing. It's called long COVID. You know, we've all been dealing with COVID now. One in five people who have had it are having significant cognitive problems and we're starting to see certain areas of the brain be very slow. The frontal poles from above their eyebrows about an inch in, that area is impaired. That affects decision-making, organization and we're seeing different abnormal patterns with long COVID that we didn't see before with other conditions so that's I think going to be very useful plus because we include heart rate variability data, we're able to look at the autonomic function at the same time but which is also impacted with long-haul syndrome or long COVID so that's one reason. Anyone who's had a history COVID but now we're like let's take a look because we want to treat anything we can treat. Other conditions pre-COVID years, a couple two years ago, PTSD, depression because there's different subtypes of depression, there's different subtypes of ADD. It's not all dopamine receptor problems in the frontal cortex that is affected with stimulants. There are different subtypes. Some people have excess beta even beta spindling and for that subtype, the last thing you want to do is give them a psychostimulant with norepinephrine binding. That's contraindicated with a brain pattern like that yet they still meet criteria for ADHD but they need a different treatment so it helps us differentiate and discriminate the problem that the brain is having not just diagnostically but what's the functional reason for the symptom? So pretty much any cognitive related problem a person has is related to thinking, processing speed, memory, motor function, sensory function, mood. All these are brain functions so we start there. We do not want to neglect the enteric nervous system of course so we don't do it in isolation of other other testing like you know, inflammation for the body, CRP, homocysteine, things like that but it's really an important tool for most patients that are coming in with symptoms.
Dr. Wong:
Thank you and how does the brain mapping tests help to uncover root causes of those
conditions if it can do that?
Dr. Hagedorn:
Yeah. It's a very very sensitive test but the specificity is not high so what I mean by that is it's very sensitive to subtleties but you can't tell exactly what condition a person has from it. You get clues and you get ideas. I mean when you get better and better at looking at it, your accuracy goes up quite a bit on what type of condition or conditions the person has but the sensitivity is really a strength but the specificity, it wasn't designed to pair up with an ICD-10 and those are symptoms. ECD-10 and DSM-5, those are symptom categorization tools. They're not functional names or labels so when you say you have depression, great, I can put that in in the chart you've got depression but it doesn't tell me why. If you had a head injury from a car accident now, I know why you have depression. You damaged the frontal lobe so depression has a cause. The brain mapping is sensitive and helps us undercover the causes of the problem and what subtype of depression you might have or what some type of anxiety or inattention or memory loss you might have. That's the value of it really.
Dr. Wong:
So, I think what I hear you saying is that it's time to overthrow the tyranny of the diagnosis, time to overthrow that monarchy maybe?
Dr. Hagedorn:
Yeah. I mean it's a useful tool in differential diagnosis so I'm trying to just discern what it is. For example, we do a work up on a person who's coming in with suspected Alzheimer's, we're up front why they have that. Just because they have a terrible MoCa score, they've got cerebral shrinkage or atrophy on MRI, that doesn't tell me why. And then, we do more testing and sometimes we're surprised. You know, most recently, we've seen a patient without question it's from mold and we suspected it but the brain mapping did not look like Alzheimer's. It did not have the same pattern yet the person's cognition was really impaired and you do a more detailed history when you see that pattern, you say it's not adding up and you then do some additional kind of expensive mold toxicity testing and lo and behold, it's off the chart and then you start to put the pieces of the puzzle together so we do use it for differential understanding as well.
Dr. Wong:
Right. Like that person like you said with “dementia”. I know we've had people that had “dementia” but it turned out to be depression or like you said, it turned out to be mold toxicity. What is the pattern that you see on the brain mapping for mold toxicity?
Dr. Hagedorn:
Yeah. It can be one of two things. We have very global low power in the brain but we also sometimes see neuroinflammatory process going on depending on the stage or how acute the exposure might be so we can see one of two but also what we don't see so if a person has a normal peak alpha, say a 10 hertz, their P300b is normal, it doesn't add up with atypical neural regenerative dementia so we're looking at it and we're thinking okay it's not that, it's got to be something different that's causing the impairment so it forces us to look a little bit deeper. So sometimes, it's the absence of markers that helps clue us in as well but you know you mentioned pseudo-dementia which is you know, when an older adult depression, they will present with dementia symptoms. We've all known that for decades. That's very easy to see. I mean you see frontal low power in alpha, sometimes it's dominant on the left hemisphere, very clear pattern and then you'll see P300b very delayed, low peak alpha like below eight hertz and we'll often see posterior slowing. We see that appears to be correlated with say an amyloid PET scan in a later stage but we will see the depression component quite easily but also it's sometimes both. You know, we have a person with degenerative dementia like an Alzheimer's, they will also have depression. It's not one or the other, it's both and that helps us to treat both because we can see both on the test results and not just give Aricept but maybe look at treating with antidepressants as well.
Dr. Wong:
Great, thank you so much. And you mentioned before how sometimes you'll see on the brain map, there's some indication on there that there could be some hormone imbalances, maybe low T or maybe they need to you know, do some bioidentical hormones or whatnot or you know different supplements, etc. to support that hormone axis. What's the interplay between the brain health but also between brain health and also gut and hormone health? And that's a pretty broad topic there but we know from a systems biology approach, that's something that's very useful to discuss.
Dr. Hagedorn:
It honestly should be the question every clinician asks, you know? What is the relationship between the heart and the brain, between the brain and the enteric nervous system also called the second brain which can function independently off the main brain and the research is crystal clear on this. Anyone that is not treating this manner today really needs to catch up because the entire nervous system is tremendously powerful in treating the brain and it's really our first go-to area of treatment because it has such a profound effect on cognition and brain health to make sure the enteric system is solid and then obviously the endocrine system, all the hormones are related to that as well so those are also very easy with lab testing, with urine testing, blood testing, saliva. You can get a really good window into the hormone system and cycle for a person very quickly and expensively so when you do a treatment in like a triad, thinking of it in terms of central nervous system, enteric nervous system, endocrine system you know, it's almost all patients get better and we're not really treating anymore, we're curing. A big difference. A lot of Medicine is designed, unfortunately, to just treat the problem of the day. We should at this point in the medical history be curing problems.
Dr. Wong:
Right. So, we need to go from a la carte treatments for single isolated ICD-10 diagnosis to more like systems biology treatment, CNS, enteric nervous system, endocrine system. That’s great.
Dr. Hagedorn:
That's how Medicine was designed. I mean in medical school, you first learn the biology, the cell chemistry to cure what's the underlying reason. Somehow, that gets lost in residency when you're doing 100 hour work weeks and then that seems to be the pattern and it's very unfortunate. We need to go back to the basics.
Dr. Wong:
And speaking of some of the fundamental foundational pillars of health, how does nutrition impact different brain disorders such as anxiety or depression here?
Dr. Hagedorn:
How does the system?
Dr. Wong:
I'm sorry, how does nutrition? How does nutrition and food?
Dr. Hagedorn:
Yeah, very good question. I mean everything you put in your body and it wasn't really Hippocrates who said this if people do the history you know, “let food be your medicine”. He gets credited with it but it actually has another source. I won't go into the history of that quote but..
Dr. Wong:
I'd love to discuss that. Yes.
Dr. Hagedorn:
Yeah but the principle is still strong. I mean what your body is exposed to, what water hits your body from your shower and the amount of chlorine in it affects your body, what toxins are in your air, what plastics in your water. All of those are impacted and are changing you at a cellular level and hurting the enteric nervous system which is a sensitive system to filter out poisons and take in good nutrients to make neurotransmitters, to improve your immune system so all of that is happening from the day we're born and we start to degrade because of the poisons and toxins in our system and some people can shed those better than others but then nutrition of course is part of that. If you're living a life on Big Aacs and you know, no offense to McDonald's but you know, there's a lot of fit foods in America in particular that were designed to taste really good but not really be good for you. There are different foods that reduce inflammation in the body like turmeric, different types of foods essential fatty acids from certain fishes, mackerel for example. You're trying to undo some of the damage that happens to you everyday from the exposure to a toxic world that we're in and it has an impact on behavior. For example, if you don't have zinc, magnesium in your system, you're not absorbing it, how are you going to make dopamine? You know, you need precursor nutrients in your diet just to manufacture neurotransmitters which your brain needs to think so we need to look at a systems approach and nutrients is very important. What you do put in but also what you shield yourself from by reducing the amount of toxic exposure. All of that has an aggregate benefit for brain health and body health.
Dr. Wong:
I was listening to a podcast today in the morning and I was just listening and it kind of blew me away that chlorine is actually an antimicrobial and a gut microbiome disruptor and so even though we're you know, in our showers and we're probably trying to relax during that time, we're also getting exposed to chlorine unless we have the water filters that would help that to filter that out. And then, the other thing you said was about the nutrients and I'd like you to discuss the role of fats a bit because we know the brain's about 60% fat, is that correct?
Dr. Hagedorn:
Just commenting on has to do with nutrition and the role of nutrition and brain health and we know that fats are important. It's an important component and again, that's why we have lab tests to make sure that we don't have abnormal ratio of bad cholesterol. You can look at all those things and monitor that but we need fats in the brain and like MCT is one of the types of fat medium chain triglyceride like in a coconut oil for example that can be very good for you when you have cognitive impairment. We always do things in measured steps. Don't go overboard with any new idea but we monitor against the entire body in a person's body so essential fatty acids and fish oil, EPA, DHA has a role, nuts, avocado, more and as we get older, our brain doesn't use glucose as efficiently. We need more ketones. It's the only two fuel sources the brain can use and as we get older, ketones become more useful to the brain as a way of fueling it so there's a shift towards ketotic. We call it keto realistic because to be purely ketotic is extremely difficult. People that do it, we have seen reversal of that type of severe dementia so it can be very powerful. We know that cancers can't survive when a person is totally ketotic so there's a lot of advantages to it but it's not easy to do but even being keto realistic can have a big and profound impact on cognition.
Dr. Wong:
Thank you. You mean by keto realistic, keto friendly type diet with a little bit of carbohydrates, is that?
Dr. Hagedorn:
Yeah, that's right. Not going overboard, yeah. There are pros and cons to that. You know, I'm old enough to remember the days when people were having so much vitamin E to cure all ailments and then they become toxic on vitamin E so you know, we want to be wise and systemic in our thinking with these things.
Dr. Wong:
Yeah. Now, what are some of the treatments that can stem from doing a brain mapping test so they have the test, they show and I do say to everyone also that if they're doing a test for instance and we see a result you know, no one has a perfect brain you know, no one has a completely green brain map. I think that's really important to say but what are some of the treatments that can stem from having this test?
Dr. Hagedorn:
Sure. Well, but first of all, I do see occasionally all green brain maps when people are perfectly healthy. It's normal and it's wonderful to see. Most clinicians don't see it because those patients don't come to see you so you know, the healthy ones don't go see the doctor.
Dr. Wong:
Yeah.
Dr. Hagedorn:
But I have the advantage of testing a lot of special operations people in the military and they're pretty normal you know, they're usually very smart etc., but what it does is it can guide a lot of different interventions both on a peak performance side but on the clinical side as well. For example, you can use the EEG data in a quantitative EEG data to select frequencies and location on the brain for things like transcranial magnetic stimulation, direct current stimulation. You can target problems very accurately now deep within the brain and cause it to change very quickly even in one visit, you know, tinnitus for example, ringing in the ears as typically a central processing problem not always an auditory system but it's processed centrally and we can see that clear on the EEG and we can target that with a TMS coil and reverse it and they'll get you know, momentary relief when you're on target and then this is more sustainable as you do it over again and again. That's one example. Neurofeedback would be another example where you can identify the frequency that's abnormal, the location on the brain, the surface sensor location and train the person back so when I mean train, neurofeedback is a training tool to change the brain just like learning to ride a bike, learning to play the violin, you're training the brain to rewire differently so with neurofeedback, you're using two modalities. Something called long-term potentiation which is when neurons fire together, they wire together, causing rewiring and then also learning theory is involved there as well when you're rewarded, there's release of dopamine and the synaptic cleft, it's rewarding so it's a combined mechanism of action very very effective with certain conditions like ADD, certain types of head injuries, certain types of depression, it really should be first line therapy. It's that effective and it lasts. You don't have to do the treatment forever. Once you're done, you're kind of done like once you learn to ride a bike, you're not going to forget just because you don't ride it for a couple years.
Dr. Wong:
Right. It's an internal treatment that you're kind of teaching yourself to do as opposed to an external treatment like a medication or something like that's gonna kind of not really be long lasting because it's not really teaching you anything in a way.
Dr. Hagedorn:
Well, there's also another benefit from it that you just kind of highlighted, you're doing it yourself. There's something inherently valuable in fixing yourself when you can take control of the problem and do things deliberately to improve yourself. It has another qualitative benefit that we just don't get when you take a pill and when cases, probably the most classic is trauma, people are exposed to early childhood trauma, later trauma in life that definitely changes the brain. A good friend of mine, Dr Bessel van der Kolk, wrote a fantastic book, ‘The Body Keeps A Score’, and those people in particular, when you can give them some control back and they can learn to train change their own symptoms, it's so powerful and it's long lasting.
Dr. Wong:
How does trauma impact our brain function? This is a big you know, I think question for our times for sure.
Dr. Hagedorn:
Yeah, it's a great topic and again, I would recommend Bessel's book on that. He covers a lot of these topics but chronic stress for example, when you have a cortisol release, when you have adrenal function or overdrive, you're damaging your enteric lining for one thing so the villi in your gut is being damaged in real time so we know if that happens, you're eventually going to have neurotransmitter, lack of production of serotonin, etc., so that's one way that you're damaging your second brain from chronic stress and sleep problems. When you're traumatized, the brain does not want it to happen again so it'll set up a pattern of processing to keep you from being hypervigilant, alert, on guard, and that high state of vigilance keeps your sympathetic branch of your autonomic system all jacked up and elevated so you have a high high sympathetic tone which is long-term damaging to your vascular system that causes hypertension, tachycardia, so that's another aspect that your amygdala and the hippocampus in your brain are always looking for danger now to try to not let you get hurt again so over time and you also are producing more cortisol and the adrenals is over-activated and that's damaging to the cells in the brain as well to have that kind of load constantly bathing the cortex so it's a combined perfect storm of body deterioration when a person is traumatized, you know? When we've lectured on early childhood trauma and you look at all the physiologic components of it, it's unsettling and insidious but it wreaks havoc on the entire body so the brain is just part of that part of the area that gets damaged.
Dr. Wong:
And if someone has trauma, what would you see typically or there's certain typical patterns on an Evoke scan?
Dr. Hagedorn:
Yeah and again, we see this, others have seen this, the classic one is when a person closes their eyes from an eyes open EEG and then they close their eyes and they're at rest. They're just sitting down like you and I right now. The right occipital parietal part of
the brain, high alpha elevates very quickly. It's typically generated from the default mode network in the cuneus insula areas of the brain so it's a very classic sign that there's some hypervigilance and it makes sense when you close your eyes, you don't have the ability to see what's coming. Your brain is now in a heightened state of alert using your auditory system, vibrations from somebody walking in the room to try to detect if danger is coming so when you close the eyes, the brain is trying to figure out how do I protect myself now that my site is removed? And that's one of the reasons we're able to see it. That's one. Also, sometimes, there's elevated beta. Beta one which is a frequency band in 15, 16 up to 19 hertz gets quite elevated as well and people that are very anxious all the time even with some OCD, obsessive compulsive traits, if it's over the anterior cingulate so the location and the frequency tips her hand to say, “Wow, we got an anxiety disorder here.”, and it prompts us to ask questions. How many times have a patient's been in and out of the doctor's office with severe PTSD and you never knew it? Because they're coming in for stomach pain, for IBS, headaches and they get treated for those things but no one asks a question, “Well, what happened to you?”, and give a moment for them to cry and tell what happened. It's tragic that it happens frequently but many many cases we see that and it's time to intervene with something like EMDR. I would do that before I put somebody on a benzodiazepine.
Dr. Wong:
Trauma is at the root cause of many health issues and I think one of I would say goals is to first acknowledge that, you know, identify that and then like you said, we can treat it appropriately with things like EMDR so there's a lot of different you know, directions we can go here but I just wanted to, first of all, just acknowledge of you know, how helpful this conversation has been for hopefully all the listeners out there that have been kind of struggling during this time and and whether now during the pandemic or even pre-pandemic you know, with a lot of these mental health, brain health issues that probably I would venture to say for most people haven't been validated, really haven't been looked at in terms of the root cause or causes and so the brain mapping tests with the Evoke quantitative EEG can be really really helpful for that but let's kind of get back to some of the lifestyle recommendations. Let's say someone has brain fog, they have some brain issues, what kind of lifestyle recommendations do you recommend to help with brain health?
Dr. Hagedorn:
Yeah, a lot. I mean again, the nutrition side is something you can do and you can get control over that and nobody else can do it for you. There is no prescription for this. So, this one is really important. Education to know what's healthy. I mean people still think french fries as a form of a vegetable you know, so it's like okay we need a little bit of basic knowledge. This can go a long way and in a varied diet, making sure you don't have certain food allergies to certain things. That would be the starting point to what you can do. There's different types of exercise that are useful, that their body needs you know, certain ways of helping improve oxygenation. Keeping your sugar level down is probably one of the single most important things, particularly in America with our crazy diet, is high a1cs, high glucose members, those are just inflammatory vascular inflammatory condition that you can reverse. It's something that's reversible. If you do it early, you'll keep your feet, you'll keep your legs, you won't have diabetic neuropathy, you won't have cardiovascular diseases, there's a lot you can do nutritionally and sugars is a big problem so that would be one thing to start with. Let's cut those out.
Dr. Wong:
I think we should rename the standard American diet, the sugar added diet, SAD.
Dr. Hagedorn:
Yes, yeah. It's more. I mean that because it will make you sad. Absolutely will make you sad.
Dr. Wong:
It'll make your brain sad. It inflames your brain. Sugar increases inflammation. Inflammation damages the brain cells. How important is sleep in all this with brain health? And does sleep affect the Evoke on a day to day basis, on a test to test basis if you have someone that gets seven hours, of eight hours perfect sleep, they sleep through the night versus someone that got four or five and they're dragging the next day. How is that gonna affect?
Dr. Hagedorn:
It's not gonna make a big difference on the brain map results. You know, one night, I don't get a few hours of sleep. When you have chronic deficit of sleep like you're sleeping three or four hours over months, you're gonna have such significant slowing in processing speed, the brain power processing is always slow, your parasympathetic system will be quite elevated relative to sympathetic, you'll see a lot of deep fatigue there. What is useful, however, and we will usually use it to order a sleep study is if you see excessive low power in the frontal poles, fp1 and fp2. That will usually trigger that we need to look for sleep apnea because you can have people with sleep deficits and it's because of apnea, you know? Their brain, their body’s being woken up throughout the night because of the oxygen carbon dioxide level in the body and that's a problem so we use it from a sleep standpoint looking at possible apnea. That's one area and then there's if you have over activity, central nervous system overactivity, which is seen in a beta that is very high in the parietal occipital area that's inconsistent with sleep. You can't have a brain processing that fast or racing and close your eyes and think you're going to drift off to sleep. So, there are different tools that can help where you can train. It's called sensory motor rhythm. It’s from the left ear to the right that has that strep through the brain called sensory motor rhythm. That could be trained with neurofeedback to improve sleep. That's a good product out of France that does that. Also, there's things like audio-visual entrainment where you put frequencies into your eyes and ears. a product, Mind Alive, from Canada is a very good one and you can send a slow frequency pulse in that will help slow the brain down because the brain will start neurons, neurons will start to fire at a slower pace and calm the brain down and I've used that with you know, career military snipers for 21 years who just can't sleep. You know, the brain doesn't shut off and this is one tool that is non-invasive. They put it on at night and can start to fall asleep and if they wake up in the middle of night, they just turn it on again. So, there are tools to help modulate the brain non-invasively and AVE or audio-visual entrainment is just one of them and again, we use the brain map data to tell us what frequencies and what treatments might work, you know? We kind of use that data to kind of brainstorm. What am I going to throw at this person that's going to stick? It's kind of a little bit of a cheat. It's like a cheating guide I guess. You use a brain map to kind of cheat instead of guess.
Dr. Wong:
Tests don't guess, right?
Dr. Hagedorn:
Yeah.
Dr. Wong:
Do you see any differences on brain mapping between people that meditate regularly versus those that don't?
Dr. Hagedorn:
Yeah and it's you know, you'll see a lot of algorithms. I mean it's just off the chart and it's like they close their eyes and they're meditators. The brain just fills up with slow alpha. So either one or two things, I'll say either say you're smoking a lot of marijuana or you're a really good meditator because you'll see a lot of frontal alpha from medical marijuana use as well and when I see college students, they're saying, “Hey. I have ADD. I need a stimulant.”, and I'm looking at that level of frontal alpha. I'm like, your problem with attention is too much weed. I mean from a lot of smoking, you know? That's what do that first.
Dr. Wong:
For cannabis. Well, I know that some listeners will have this question so let's talk about real quick, what are your top three and there's probably more but let's talk about like top three nutraceuticals that you might recommend if someone is looking for something as a little boost, a little bit of an edge for brain health?
Dr. Hagedorn:
Okay. I'm just again, go back to the second brain. You can do so much for this brain by fixing this brain.
Dr. Wong:
I love that.
Dr. Hagedorn:
Let's start there. L-glutamine, vitamin C, prebiotic, probiotic, digestive enzymes, a little bit of black pepper extract to help with absorption. That combo is magical. If you can add colostrum to it even, it's fantastic. Again, colostrum is from mother's milk early state or collagen are the types of collagen for the gut so if you were to add that combo and fix your enteric system, in adults, it takes as much as three months, kids for about four weeks of gut work repair, you're going to do more for your brain, your central nervous system brain than phosphatidylserine, from ginkgo, from all the things that we think about that are focused on the brain. Fix your second brain because then, every time you put something in your mouth, the body doesn't assume it's a foreign body and needs to have a cytokine reaction against it so you fix the enteric, you're gonna fix this. That by far is the best bang for the buck.
Dr. Wong:
Great. Thank you so much. A little bit of nutritional neurology here. That's great. And finally, we have some fun closing questions for all of our guests so I just want to ask you, do you have a morning routine and if so, do you mind sharing that with us?
Dr. Hagedorn:
No mind at all. I hear my alarm go off, I wish it didn't. That's the first phase. I hit the ground, coffee pot goes on. I'll try to get a shot at that combo I just told you for the gut. I'll try to throw that in the glass right away and a little bit of water slug it down because you want it on an empty stomach.
Dr. Wong:
Okay.
Dr. Hagedorn:
And then 15 minutes in before you eat anything, you've got it hit, you coated your system with it, absorbs quickly before you put anything else in your mouth so that's actually the best routine and then you know, the typical get ready to go to work thing that most people do. Try to have a diet in the morning with protein. Protein is important to have in the morning. Your body needs some good varied protein.
Dr. Wong:
Great. What book or podcasts are you enjoying the most right now and what is it about and why are you enjoying it?
Dr. Hagedorn:
You know, it's very recent. I just got it. It's called ‘Behold Israel’ and it's a person who was in the military, in Israeli army, but he's taken us through the history of what's going on in the Middle East through the biblical lens from the Old Testament, in the New Testament and it's just absolutely fascinating what's going on, what we don't get in our Western media, doesn't show us so that, I really am enjoying. So yeah, the old Israel's been pretty powerfully influential in me and how I think about the world and how I'm treating other people and trying to put their lives and their needs ahead of my own. Helps in my marriage, helps to take care of my children to think about their needs and how I can be more of a servant than be seen when it needs to be served so that for sure has really been life-altering for me.
Dr. Wong:
Great, that's awesome. And what do you do everyday to cultivate joy?
Dr. Hagedorn:
I have joy all the time. I mean I enjoy what I do. I mean I don't really go to work, I go to play. I mean helping people when they come in and they cry and they say my mother told me I was worthless my whole life and you're telling me I don't have these problems. I'm looking at the brain map and they see a path towards a future health, the future benefit that they can control. It's priceless. You can't buy that kind of joy. Joy comes from doing things for others, not for yourself. Buying a new car, buying a boat, sitting on a beach does not cultivate joy. Doing things for others, that cultivates a real joy.
Dr. Wong:
The best advice and that's incredible, the work that you're doing and thank you so much again Dr. Hagedorn for coming on our podcast today and how can listeners learn more about you and work with you?
Dr. Hagedorn:
By just call. Anyone who calls or has a question, I'm happy to help.
Dr. Wong:
Great. Well, thank you so much for taking the time to listen today. If you enjoyed this podcast, this conversation, please take a moment to leave us a review. It helps our podcast reach more listeners and this has been incredibly informative talk and conversation with Dr. David Hagedorn today so again, thank you so much David for being with us and thank you so much to the listeners too. And if you have any questions or
comments you know, we'll probably be doing some sort of interactive chat at some point but I think at this point, just leave your comments in the reviews and don't forget to subscribe so that you don't miss out on our next conversations. Have a great day everyone.