by Dharma Singh Khalsa, M.D.
The 21st Century Brain
Anti-aging and life extension are all the rage these days, and with good reason. High-quality research continues to document the marvelous resilience of the human body. The informed public is coming to expect more years of life with better quality of living. The anti-aging experts predict that many of us who are now middle-aged will definitely exceed 100 years and perhaps reach 120. Yet fully half of the population over the age of 85 have the dreaded Alzheimer’s disease or functional mental loss of similar degree. What good would it do any of us to have to spend the last 35 years of our life hardly knowing where we are or even the most basic, who we are? Dr. Dharma Singh Khalsa offers us a brilliantly developed solution to this paradox in his landmark book Brain Longevity: How to Regenerate Your Mind for Peak Mental Performance (Warner Books 1997).
Dharma Singh Khalsa, M.D., is a charismatic figure. Trained at the University of California–San Francisco, Harvard and other elite medical institutions, he is authoritative as well as charming and personable. He is one of that special breed of physicians who have the courage to defect from the establishment and join the movement for high-quality health care. In this new 450-page book, with the help of experienced health writer Cameron Stauth, Dr. Khalsa explains the program that often successfully revitalizes the brain. Though I take issue with some of the program’s details, I enthusiastically agree with the thrust of it. It is a breakthrough for preventive brain maintenance and can be used as a model for preventive maintenance of the body’s other organ systems.
The Khalsa program is particularly strong and resourceful because it draws from both Eastern and Western medical traditions. It is deeply rooted in ongoing clinical and basic science research and it encourages a diversity of health building practices. Even more, it sincerely encourages the patient to become more involved in his own health and to take charge of his life. The idea is stated clearly that “virtually anyone can take control of the care and feeding of his or her own brain, with wonderfully positive results.”
The Khalsa brain longevity program starts from the premise that the brain, like every other organ, is flesh and blood. The text documents, in understandable style, how the brain resembles the other organs in having the capacity to bounce back after it has been damaged. This program really is holistic (I prefer the term “integrative”) because it uses the widest variety of available options to encourage the brain to heal itself.
Among these are:
- Nutrient supplementation and dietary revision
- Life style improvements, exercise (physical and mental)
- Stress management, meditation, yogic relaxation
- Pharmaceutical intervention, where indicated.
Throughout the text Dr. Khalsa refers to cutting-edge research to justify his treatment strategies. For example, he recognizes a crucial role for stress in brain deterioration as established most effectively by the work of Professor Robert Sapolsky at Stanford University. He carefully unravels complex features of brain structure and function. He discusses Marian Diamond’s and K. Warner Schaie’s research which proves that environmental enrichment can help build mental function at any age. Another feature that makes this book classy is that Dr. Khalsa doesn’t pretend that all this was his work alone–he gives to many brain researchers the credit they deserve for their contributions.
Just as Brain Longevity is loaded with good science, as a source of pragmatic solutions it is very strong. It effectively details how to estimate roughly on one’s own just how much of a problem one may have, by making available simple mental tests that can be done in private. It goes into all the different steps to correct one’s mental impairments. It goes into depth about meditation and yogic relaxation techniques, which do need more popularization. It encourages the worried individual that “it is never too late” to regain lost mental performance.
Of course, whenever I review a book I also have to be alert for weaknesses. I didn’t find many in Brain Longevity–it is an awesomely effective piece of work. Coming from my point of view on brain nutrition, the closest I can come to an overall criticism is to suggest that (at least for those of us who don’t like to take lots of supplements) more of an effort could have been made to prioritize the many brain nutrients that are discussed. If the consumer is to be spared having to take 30 to 50 tablets a day, some would like to have criteria for judging which nutrients to take first, which second and so on. It’s a fact that all nutrients are good for the brain in one way or another but some are better proven than others to give exceptional benefit. Certainly phosphatidylserine (PS) doesn’t get the priority it deserves–it is far more than a “natural medicinal tonic.” In my opinion, PS is the single nutrient most proven to benefit the declining or pre-Alzheimer’s brain.
Brain Longevity has a few inaccuracies, such as in describing DHEA as a “mother hormone.” This designation more justifiably belongs to pregnenolone, and ironically, DHEA can masculinize women if used at too high a dose. The recommended intake of Coenzyme Q10 is probably too low. However, the countless clinical pearls that are liberally scattered throughout its 20 chapters more than make up for any inaccuracies. One pearl is that meditation increases the brain’s natural production of melatonin, thus lessening the need for supplementing with melatonin. Another is that the stress response can literally poison the brain, as we already knew it could poison the heart. Drugs are discussed responsibly and are sometimes recommended, but in a context consistent with Dr. Khalsa’s own “Nutrients First” practice of medicine. To their credit, the authors make the important point that certain so-called “smart drugs” can overstimulate the brain.
Perhaps the single most unique feature of Brain Longevity is the vision that it puts forward for the future management of memory loss and other degenerative mental conditions. It gives figures for a likely coming epidemic of Alzheimer’s: from 4 million now (currently half of all nursing home admissions) to 10 million in 15 years. Dr. Khalsa’s vision is to delay or prevent Alzheimer’s in the vast majority of these susceptible individuals, thereby saving society both tremendous pain and financial cost while also swelling the ranks of the elderly with people who have revitalized mental function and wisdom to spare. I share this vision, but because of the current state of health care, we will probably need a full-scale political movement to achieve it.
Brain Longevity is truly an exceptional book, a book that takes a big step towards a new age in health care. The Khalsa program that it describes stands in marked contrast to the HMO and managed-care model. The program is far more medically effective, gives the patients more power to help themselves and gives a whole lot more value for the money spent. Components of the Khalsa program can be used productively by every medical practitioner and institution in their efforts to manage or prevent virtually any disease. Implementation of this program would generate remarkable savings, not only in money not spent but also in suffering not experienced. Written far more competently than most other “anti-aging” books, Brain Longevity: How to Regenerate Your Mind for Peak Mental Performance is essential reading for anyone who is over 40, or for younger people who suspect their brain function is impaired for whatever reason. If you hope to stay mentally alert to yourself and your surroundings as you go through life, the $25 (or less) you’ll spend on this book will be well spent. It will give you an infinitely high return on your investment in the currencies of health, intelligence, and happiness.
Brain Longevity is a timely contribution to the medical strategy against Alzheimer’s. Unfortunately at this time it is politics and greed, not science, that stand in the way of Dr. Khalsa’s vision. The overwhelming trend in health care these days is managed-care. This is the term used to describe the growing dominance of the HMOs (Health Maintenance Organizations). If a network of Alzheimer’s prevention clinics comes into being, it will be either as part of the HMO system or in competition with it. Either way, such a network will have to be innovative to survive. The HMOs put profit first and have set new standards for degradation, not only of their patients but also of the doctors and other health practitioners who work for them.
Recently I walked into a little cafe in my neighborhood where they have local newspapers. On the cover of a newspaper called the San Francisco Bay Times I saw the face of a man I know. His name is Jon Kaiser and he is an M.D. who practices holistic AIDS medicine; he’s rather a parallel for the immune system to what Dr. Khalsa does for the brain. I read that Jon had been fired after his clinic was bought by a national HMO chain. And why, since he’s acknowledged to be the best all-around physician for AIDS patients? Because his new bosses felt he was spending too much time with his patients–up to one hour per visit. Well, let’s not be too surprised because the HMOs are Big Business–they sell health care for profit.
Jon Kaiser happens to be a white male and other white males have also been victimized by the HMOs. An even earlier pattern of the HMOs was systematically to exclude non-white and female practitioners. An article in The Sun-Reporter newspaper of San Francisco quotes Dr. Natalie Carroll, a black OB-Gyn physician, as saying that managed care discriminates blatantly, and that “managed care has become mangled care.” I am not exaggerating when I tell you that doctors from all backgrounds are complaining that HMOs are interfering with what they are trained to do. As a rule, all practitioners who respect their patients and conduct themselves as caring professionals will come into conflict with their HMO.
Another set of barriers to innovative medical practice are the Draconian practices of the medical “quality” boards and the regulatory agencies in various states. Most of these are anti-democratic–they are prejudiced against new medical developments and discriminatory against innovative caregivers. They promote a style of medical practice that is motivated primarily by hostility towards change.
Consequently, such practice is out of sync with emerging clinical research findings. This exclusionary style of practice combined with the greed-driven style of the HMOs deprives the patient population in order to enrich “high-tech” suppliers and their friends. Seems to me that all of us who want quality health care are going to have to get together and build a new model for health care delivery. This model would give patients the time necessary for adequate evaluation, diagnosis and treatment. It would respect all those who participate in the health care delivery process, including the nurses, the support staff, the doctors and the patients. It would have to give the patients maximum healing value for their money, while fairly compensating the staff. It would have to be non-discriminatory and community-based.
But some may ask how can this idealistic brand of responsible health care compete sufficiently with the present corrupt health care practices eventually to win out? Please do not get me wrong on this point–I am not against high-tech medicine. In fact, my earlier laboratory career familiarized me with research of this type and I know it has an important place. However, it is one style of medicine among many styles that can and should coexist within the same health care system. For this reason, I am proud to be part of the ever-expanding movement demanding the integration of holistic, preventive practices into the nation’s health care system.
I appeal to you, the reader, to stand up and resist whenever your health needs are not being met, or whenever a caregiver that you respect comes under attack for trying to take care of your medical needs.
Here I have three strategy suggestions. First and foremost, the dominance of greed in the current delivery of health care must be curbed. In my opinion, this factor more than any other is the source of the ongoing abuses and disrespect towards patients and honest caregivers. Reasonable profit needs to be defined and appropriate controls put in place to limit gouging. Second, with greed comes corruption. Some of the financial arrangements that currently are legal, such as incestuous cross-referrals between facilities co-owned by the same individuals, should be re-evaluated. Thirdly, U.S. health care is about as lacking in diversity and tolerance as is U.S. race relations, and (as with race relations) an institutionalization of these features is essential for the situation to improve qualitatively.
Medical institutions cannot effectively conduct public health education, coordinate preventive outreach programs, run emergency rooms and treat disease unless they can have the confidence and involvement of all sectors of the population. With wider diversity and greater tolerance come better scientific, gender, ethnic and financial experiences and options.
In other words, we would all learn from each other while we build a more holistic, integrative and egalitarian health care system.
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