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How to Improve Brain Health & Offset Neurodegeneration | Dr. Gary Steinberg

In this episode, my guest is Dr. Gary Steinberg, MD, PhD, a neurosurgeon and a professor of neurosciences, neurosurgery, and neurology at Stanford University School of Medicine. We discuss brain health and brain injuries, including concussion, traumatic brain injury (TBI), stroke, aneurysm, and transient ischemic attacks (TIA). We discuss key and lesser-known risk factors for brain health and explain how certain treatments and medications can improve brain health and cognitive function. We also cover novel mechanisms to improve recovery after concussions and brain injury, including the use of stem cells, temperature (mild hypothermia), and vagus nerve stimulation. Dr. Steinberg also describes new advances in neurosurgery and minimally invasive brain augmentation. This episode ought to be of interest to anyone seeking actionable tools to improve their brain health and for those seeking to improve recovery after a brain injury such as concussion, stroke, aneurysm, or TBI. Thank you to our sponsors AG1: https://drinkag1.com/huberman Eight Sleep: https://eightsleep.com/huberman ROKA: https://roka.com/huberman AeroPress: https://aeropress.com/huberman LMNT: https://drinklmnt.com/huberman Dr. Gary Steinberg Stanford academic profile: https://stan.md/3WLmBV2 Stanford Health Care clinical profile: https://shc.is/4dProuA Lab website: https://stan.md/4dKFnlA "Why I Went into Medicine: Gary Steinberg, MD, PhD" (video story): https://youtu.be/m5kEvuaSEuY Publications: https://stan.md/3WMNCaw Articles The fasciola cinereum of the hippocampal tail as an interventional target in epilepsy: https://go.nature.com/3UP80oZ Transplanted Stem Cell-Secreted Vascular Endothelial Growth Factor Effects Poststroke Recovery, Inflammation, and Vascular Repair: https://bit.ly/3UFNRSg Human neural stem cells enhance structural plasticity and axonal transport in the ischaemic brain: https://bit.ly/3UQFByY Revisiting Stem Cell-Based Clinical Trials for Ischemic Stroke: https://bit.ly/4bH4jZk Two-year safety and clinical outcomes in chronic ischemic stroke patients after implantation of modified bone marrow–derived mesenchymal stem cells (SB623): a phase 1/2a study: https://bit.ly/4bHLNzT Mild Hypothermia Reduces Apoptosis of Mouse Neurons In vitro Early in the Cascade: https://bit.ly/4bH4pjE Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest: https://bit.ly/3UNY0wb Childhood Outcomes after Hypothermia for Neonatal Encephalopathy: https://bit.ly/3UPvvy5 Slow rewarming improved the neurological outcomes of prolonged mild therapeutic hypothermia in patients with severe traumatic brain injury and an evacuated hematoma: https://go.nature.com/3UQhiRy Vision Loss after Intravitreal Injection of Autologous “Stem Cells” for AMD: https://bit.ly/3UFO5c4 Huberman Lab Episodes Mentioned Dr. Craig Heller: Using Temperature for Performance, Brain & Body Health: https://youtu.be/77CdVSpnUX4 People Mentioned Timothy Schallert: professor of psychology, University of Texas at Austin Theresa Jones: professor of psychology, University of Texas at Austin Norma Shumway: father of heart transplantation, Stanford University Henry Kaplan: discovered radiation exposure to treat leukemia, Stanford University Timestamps 00:00:00 Dr. Gary Steinberg 00:01:44 Sponsors: Eight Sleep, ROKA & AeroPress; Subscribe on YouTube, Spotify & Apple 00:06:16 Stroke, Hemorrhage & Blood Clot 00:10:25 Blood Clots & Risk Factors, Medications, Smoking, Cholesterol 00:16:19 Heart & Brain Health; Neurosurgery & Brain Function 00:23:27 Current Technology & Neurosurgery, Minimally Invasive Techniques 00:28:13 Transient Ischemic Attacks (TIA); Spinal Cord Strokes 00:33:23 Stroke Risk: Alcohol, Cocaine & Other Drugs 00:38:24 Sponsor: AG1 00:39:55 Traumatic Brain Injury (TBI), Concussion: Sports, Testing & Recovery 00:46:45 Statins; TBI & Aspirin; Caffeine & Stroke Risk 00:48:31 Exploratory MRI: Benefits & Risks 00:51:53 Blood Pressure, Lifestyle Factors; Tool: Feeling Faint, Hydration; Sleep 00:59:52 Sponsor: LMNT 01:01:27 Chiropractic Neck Adjustment & Arterial Obstruction; Inversion Tables 01:05:16 Kids, Tackle Football, Soccer, Boxing; Mild Concussion 01:10:49 Nerve Regeneration, Stem Cells, Stroke Recovery 01:17:36 Stem Cells, Immune System, Activity 01:21:27 Injury & Recovery, Restraint Therapy 01:23:46 Neuroprotection After Injury; Mild Hypothermia 01:34:59 Platelet-Rich Plasma (PRP), Stem Cell Therapy 01:42:27 Scientific Advancements & Clinical Translation, FDA & Industry 01:47:40 Vagal Stimulation 01:53:17 Zero-Cost Support, Spotify & Apple Reviews, YouTube Feedback, Social Media, Neural Network Newsletter #HubermanLab #BrainHealth Disclaimer: https://www.hubermanlab.com/disclaimer

Andrew HubermanhostGary Steinbergguest
May 19, 20241h 55mWatch on YouTube ↗

At a glance

WHAT IT’S REALLY ABOUT

Preventing Stroke, Healing Brain Injury, And Harnessing Neuroplasticity With Steinberg

  1. Andrew Huberman hosts neurosurgeon Dr. Gary Steinberg to explain how blood flow supports brain function, what happens in stroke, aneurysm, and hemorrhage, and how to recognize and reduce those risks. They cover clotting and bleeding factors, lifestyle contributors such as smoking, alcohol, drugs, blood pressure, and cholesterol, and the sometimes subtle presentation of TIAs and spinal strokes. Steinberg describes remarkable advances in minimally invasive neurosurgery, concussion management, hypothermia for neuroprotection, and especially stem cell and vagus nerve–based therapies that can restore function long after stroke or traumatic brain injury. Throughout, they emphasize practical, evidence-based tools anyone can use to protect and improve brain health while debunking unsafe or overhyped practices like unregulated stem cell clinics and cervical chiropractic manipulation.

IDEAS WORTH REMEMBERING

5 ideas

Know What A Stroke Is And How It Manifests

A stroke is effectively a “heart attack of the brain”: a disruption of blood flow that deprives neurons of oxygen and glucose. About 87% are ischemic (clots in brain or upstream arteries), and ~13% are hemorrhagic (vessel rupture). Symptoms can include sudden weakness or paralysis (often on one side), speech or comprehension problems, vision loss or double vision, imbalance, or sudden cognitive changes. A TIA is a transient version of these deficits; many resolve quickly but can still leave detectable damage on MRI and signal high future stroke risk.

Target Modifiable Risk Factors: Smoking, Blood Pressure, Lipids, Drugs, Hormones

Smoking, uncontrolled hypertension, high LDL cholesterol, obesity, inactivity, and certain drugs (cocaine, methamphetamine) markedly increase stroke and aneurysm risk by damaging vessel walls and promoting clots. First‑generation high‑estrogen oral contraceptives plus smoking were especially dangerous; modern pills are safer but still not ideal for women with prior stroke or high risk. Statins lower LDL and also directly improve vessel integrity, so Steinberg often recommends them even when cholesterol is not very high, particularly in high‑risk patients.

Be Conservative With Neck Manipulation And Unregulated Stem Cells

Aggressive chiropractic manipulation of the neck can tear carotid or vertebral artery walls (arterial dissection), forming clots that embolize to the brain and cause stroke; Steinberg explicitly advises against cervical manipulation because even rare catastrophic outcomes are unacceptable. Similarly, unregulated stem cell therapies—especially outside the U.S. or in loosely overseen clinics—pose real risks, including tumors and blindness (as in a Florida eye clinic). He strongly recommends avoiding any stem cell treatment not tested in rigorous, controlled clinical trials.

Concussion Requires Rest, Not Sensory Deprivation Or Premature Return To Play

Concussions are molecular injuries that usually do not show on MRI but can be detected with sophisticated exams, including eye-tracking baselines and post‑injury testing. Total sensory deprivation (sitting in a dark room for long periods) is not advisable; instead, reduce cognitive and physical load without over‑stressing the brain, then gradually reintroduce activity. Repeated concussions—especially in contact sports like football, hockey, and soccer (notably in female players)—are now linked to chronic traumatic encephalopathy (CTE), altering Steinberg’s view on youth tackle football.

Use Lifestyle Levers To Support Cerebrovascular And Brain Health

What’s good for the heart is generally good for the brain: prioritize blood pressure control (often aiming for ≤120 systolic but individualized), exercise regularly, eat minimally processed foods, manage weight, avoid smoking and recreational stimulants, and limit alcohol (emerging data suggest that no alcohol may be optimal, with <2 drinks/week likely low‑risk). Adequate sleep (7–9 hours), hydration to maintain clear urine, and avoiding chronic overexertion and stress are key; Steinberg describes his own collapse from overwork and under‑sleep as a turning point that changed his habits.

WORDS WORTH SAVING

5 quotes

A stroke is like a heart attack of the brain.

Dr. Gary Steinberg

The brain represents only 2% of the body weight yet it draws 15% of the total blood flow and consumes 20% of the body’s oxygen.

Dr. Gary Steinberg

The old notion that these circuits are dead is simply not true. They can be resurrected.

Dr. Gary Steinberg

Even if it’s rare, it’s so devastating when it occurs that personally I would avoid neck manipulation by a chiropractor.

Dr. Gary Steinberg

There’s a lot of hope for stem cells, but despite the hope there is still a lot of hype.

Dr. Gary Steinberg

Definitions and mechanisms of stroke, aneurysm, hemorrhage, and TIAsClotting/bleeding risks: genetics, medications, hormones, lifestyle factorsBrain and spinal cord strokes: symptoms, mechanisms, and recoveryConcussion and traumatic brain injury: diagnosis, management, and sport risksModern neurosurgery: minimally invasive techniques, imaging, and brain mappingNeuroprotection strategies: hypothermia, blood pressure, hydration, sleepEmerging therapies: stem cells, vagus nerve stimulation, and neural plasticity

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