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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 20, 20241h 55mWatch on YouTube ↗

CHAPTERS

  1. 0:00 – 3:20

    Intro, Guest Background, And Episode Overview

    Andrew Huberman introduces the podcast, his guest Dr. Gary Steinberg, and frames the discussion around brain blood flow, stroke, concussion, and emerging treatments like stem cells. He previews that they will cover both acute brain catastrophes and proactive tools for improving brain health.

  2. 3:20 – 10:40

    Sponsors And Sleep, Vision, Coffee Tools (Eight Sleep, ROKA, AeroPress, AG1, LMNT)

    Huberman details sponsor products related to sleep optimization, visual performance, and caffeine/electrolytes. These segments underscore the importance of sleep, clear vision, and proper hydration and nutrition as foundational for mental and physical performance.

  3. 10:40 – 28:20

    Stroke, Aneurysm, Clotting, And Bleeding Basics

    Steinberg defines stroke, aneurysm, and hemorrhage, explaining that most strokes are due to clots and fewer to ruptured vessels. They discuss genetic clotting risks, venous vs arterial clots, and how blood thinners, contraceptives, and lifestyle factors influence bleeding and clotting.

  4. 28:20 – 36:40

    Smoking, Alcohol, Heart–Brain Health, And Vascular Risk

    They unpack how smoking and other modifiable risks affect both heart and brain, explaining that brain tissue is unique in its high oxygen and blood demand. They also address the contentious data around alcohol’s effects on cardiovascular and brain health.

  5. 36:40 – 50:00

    Inside The Operating Room: Mapping, Minimally Invasive Neurosurgery, And Brainstem Work

    Steinberg describes awake brain surgery cases where speech areas are mapped in real time, and advances that now allow safe operations in the brainstem using tiny corridors and specialized tools. He details the evolution toward minimally invasive approaches including endovascular work, radiosurgery, focused ultrasound, and deep brain stimulation.

  6. 50:00 – 1:00:00

    TIAs, Spinal Cord Strokes, And Stroke Symptom Profiles

    They clarify what transient ischemic attacks are, how modern imaging has blurred the TIA–stroke distinction, and how symptoms depend on which brain territory is affected. Steinberg then explains spinal cord strokes—rarer but serious—and how their sensory and motor effects differ by artery and level.

  7. 1:00:00 – 1:10:00

    Alcohol, Cocaine, Meth, And Vessel Integrity; Lifestyle Risk Balance

    They revisit alcohol’s relationship to stroke and highlight how powerful vasoconstrictive stimulants like cocaine and methamphetamine damage arteries and spike blood pressure, fostering aneurysms and hemorrhages. Steinberg and Huberman discuss behavior change in response to single studies and the broader issue of balancing stress, happiness, and strict risk minimization.

  8. 1:10:00 – 1:35:00

    Concussion, Sports, And Long‑Term Brain Health (49ers Experience, CTE, Soccer Heading)

    Drawing on his decade as neurosurgeon for the San Francisco 49ers, Steinberg explains concussion assessment, recovery, and evolving understanding of chronic traumatic encephalopathy (CTE) outside boxing. They discuss eye‑tracking diagnostics, the dangers of repeated head trauma, and why he would not let his own children play tackle football.

  9. 1:35:00 – 1:54:10

    Chronic Stress, Overwork, Sleep, Hydration, And Personalized Blood Pressure Targets

    Steinberg recounts his own near‑syncope episode from extreme overwork, sleep deprivation, heat, and dehydration—followed by a full cardiac and stroke workup that showed he had simply fainted. This experience led him to prioritize sleep, hydration, and moderation, and to individualize blood‑pressure targets based on symptoms and arterial health.

  10. 1:54:10 – 2:28:20

    Neuroplasticity, Stem Cells, And Recovery After Stroke And TBI

    Contradicting older dogma, Steinberg explains that adult brains produce new cells and circuits can reorganize, enabling functional gains even years after stroke or traumatic brain injury. He details how clinically tested stem cell therapies likely work via secreted factors and immune modulation, not direct neuron replacement, and why unregulated stem cell offerings are risky and premature.

  11. 2:28:20 – 2:35:00

    Constraint Therapy, Forced Use, And Timing In Rehabilitation

    Huberman raises classic animal and human studies where tying up the good limb forces use of the weaker one, enhancing post‑stroke plasticity. Steinberg confirms this “constraint‑induced” therapy can work but stresses that timing matters; forcing use too early after injury may be harmful.

  12. 2:35:00 – 2:48:20

    Neuroprotection, Hypothermia, And Why Cooling Isn’t A DIY Therapy

    They delve into decades of neuroprotection research, explaining why thousands of stroke drugs failed despite stunning animal results, and why mild hypothermia succeeded in specific clinical contexts. Steinberg clarifies how modest cooling blocks multiple cell‑death pathways and is now standard after cardiac arrest and neonatal hypoxic injury, but remains unproven for typical focal stroke and severe TBI.

  13. 2:48:20 – 2:58:20

    Vagus Nerve Stimulation, Depression, And Stroke Recovery

    They explore how implanted vagus nerve stimulators, long used for depression and epilepsy, have been repurposed for stroke rehabilitation. Stimulation of the cervical vagus, paired with intensive therapy, can modestly but durably improve function in chronically impaired limbs, likely by driving large‑scale cortical reorganization rather than peripheral effects.

  14. 2:58:20 – 3:16:40

    Translating Science: Funding, FDA, And The Long Road Of Stem Cell Trials

    Steinberg describes the 20‑plus‑year journey from a lab idea to phase I human stem cell trials, emphasizing the cost, regulatory hurdles, and need for robust safety data. He explains how promising therapies risk dying in the “valley of death” between early data and full commercialization without industry partnership and better funding structures.

  15. 3:16:40

    Practical Brain Health Guidance And Closing Thoughts

    They close by tying the science back to everyday decisions: avoiding cigarettes and hard drugs, moderating alcohol, managing cardiovascular health, sleeping enough, hydrating, and approaching interventions like chiropractic neck manipulation and stem cells with skepticism. Huberman thanks Steinberg for his decades of surgical and research work and reiterates the importance of agency in protecting brain health.

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