Brain Health: How Music and Lifelong Learning Can Prevent Cognitive Decline

In our latest Bionic Health podcast, Dr. Jared Pelo interviews neurologist-turned-entrepreneur Dr. Josh Turknett about the science of brain health, cognitive decline prevention, and how learning complex skills like music can help maintain brain function as we age.

From Neurologist to Music Education Innovator

Dr. Josh Turknett's journey is anything but conventional. After completing medical school and a four-year neurology residency at the University of Florida, he spent years in private practice treating neurological conditions. But over time, he began to recognize a significant gap between what he could offer patients in clinical practice and what he believed they truly needed.

"I came to realize that a lot of the issues I was seeing as a neurologist were related to lifestyle and preventable types of things," Dr. Turknett explains. Through his own experience with migraines, he discovered that dietary changes had a more profound impact on his condition than conventional treatments—a revelation that would eventually lead him to reconsider his entire approach to neurological health.

While still practicing neurology, Dr. Turknett pursued his passion for music, specifically the banjo. Drawing on his background in cognitive neuroscience, he began integrating principles of neuroplasticity into his musical practice. This eventually evolved into BrainJo, an innovative platform that teaches musical instruments through neuroscience-based approaches.

The "Stimulate and Support" Framework for Brain Health

When it comes to maintaining cognitive health, Dr. Turknett advocates a simple yet powerful framework: stimulate and support.

"There are two things to think about in terms of keeping a healthy brain throughout our life," he says. "We have stimulation on one side and support on the other side."

Stimulation: Fighting Autopilot Mode

Cognitive stimulation is essential for maintaining brain health, but Dr. Turknett points out that many of us, especially in established careers, operate largely on autopilot. "The more you can spend your day on autopilot, the less cognitive stimulation you've provided," he explains.

Real cognitive stimulation comes from activities that trigger plastic reorganization in the brain—essentially, learning new knowledge and skills. This is where complex activities like learning a musical instrument come in.

BrainJo currently offers instruction in multiple instruments:

• Two styles of banjo (claw hammer and fingerstyle)
• Piano
• Ukulele
• Fiddle
• With guitar coming soon

Support: Giving Your Brain What It Needs

Just as important as stimulation is providing your brain with the resources it needs to maintain existing neural connections and build new ones. Dr. Turknett identifies several key pillars of brain support:

1. Physical activity - Particularly activities that combine cardiovascular fitness, strength training, and cognitive demands (like tennis or pickleball)
2. Sleep and rest - Critical for neural recovery and consolidation
3. Nutrition - Including key nutrients like B12, vitamin D, magnesium, zinc, and copper
4. Stress management - Limiting chronic stress that can damage brain tissue
5. Social connection - Perhaps the most underappreciated factor in brain health

On the often-overlooked importance of social interaction, Dr. Turknett notes: "Being around other people, conversing with other people, being in social situations is an enormous cognitive stimulus... one of the reasons that we see [cognitive] deterioration is because of the loss of that stimulus when people are isolated."

Assessing Cognitive Risk and Monitoring Brain Health

Many people, especially those with family histories of dementia or genetic risk factors like APOE4, wonder how to assess their risk for cognitive decline. Dr. Turknett emphasizes that while there's no single test that can definitively predict risk, there are several approaches to monitoring brain health:

• Regular cognitive assessments, whether through formal testing or self-monitoring
• Basic blood work to identify conditions like metabolic syndrome or nutritional deficiencies
• Lifestyle evaluation to identify areas for improvement

He recommends foodforthebrain.org for those interested in comprehensive cognitive evaluation with a nutritional focus.

Rather than viewing cognitive health as predetermined, Dr. Turknett stresses that "we are actively influencing our risk all the time." This empowering perspective frames brain health as something we can continuously improve through our daily choices.

Anyone Can Play Music: The Science of Learning at Any Age

Dr. Turknett's new book, "Anyone Can Play Music: How to Realize Your Musical Potential with the Laws of BrainJo," challenges the common belief that learning complex skills like music becomes impossible as we age.

"The reason we can learn anything at any age is because we have this ability to change the brain at any age," he explains. "Learning complex skills relies on neurological mechanisms that we all share."

The book outlines principles for leveraging these natural mechanisms, often requiring readers to unlearn ineffective approaches taught in traditional education. It's as much about how to learn anything as it is about music specifically.

A Prescription for Brain Health

For someone in their mid-40s concerned about future cognitive health, Dr. Turknett recommends:

1. Evaluate your current cognitive stimulation - Is your work challenging your brain, or are you on autopilot?
2. Incorporate complex real-world skills - Music, dance, or sports that demand coordination and strategy
3. Ensure physical fitness - Combining low-level movement, resistance training, and occasional high-intensity exercise
4. Monitor nutritional status - Particularly for B12, vitamin D, and other brain-essential nutrients
5. Prioritize social connection - Ideally through activities that simultaneously provide cognitive stimulation

The key is finding activities you enjoy that provide both cognitive challenges and social connection—like joining a community of musicians or picking up a sport like pickleball that combines physical activity, strategy, and social interaction.

Beyond the Clinic: Making a Broader Impact

Dr. Turknett's transition from clinical practice to entrepreneurship reflects his desire to have a greater impact on brain health than the constraints of a traditional medical practice would allow.

"To actually fulfill the role that I initially signed up for... I could do a much better job doing what I'm doing now than I could in the clinic," he reflects. Through his online platform, books, and educational content, he's able to reach and help far more people than would be possible seeing patients one at a time.

This sentiment resonates with Dr. Pelo, who made a similar transition from emergency medicine to focusing on preventative health through technology. Both physicians recognize that while there will always be a need for excellent clinicians, there's also tremendous value in creating scalable approaches to health that can benefit millions.

Time Stamps:

00:01 - Introduction and welcome

00:13 - Josh's background and journey from neurologist to entrepreneur

02:59 - Josh's personal experience with migraines and lifestyle changes

03:59 - Discovering neuroplasticity and challenging fixed mindsets about adult learning

06:51 - Transitioning from clinical neurology to broader impact

10:09 - The challenge of leaving clinical practice and finding new ways to help people

11:40 - How BrainJo evolved to address cognitive health

14:33 - Musical instruments you can learn at BrainJo (banjo, piano, ukulele, fiddle)

15:26 - Assessing cognitive decline risk and preventative strategies

17:39 - The importance of monitoring cognitive function

18:37 - Key nutrients for brain health (B12, vitamin D, magnesium, zinc, copper)

20:33 - Why genetics isn't deterministic for cognitive decline

21:29 - The value of cognitive testing and brain games

23:27 - Practical advice for a 45-year-old to prevent cognitive decline

24:03 - The "stimulate and support" framework for brain health

29:19 - What types of physical activity are best for brain health

33:08 - The surprising importance of social connection for brain health

36:46 - Josh's new book "Anyone Can Play Music" and the science of learning

40:31 - Conclusion and where to find more information

Learn More

To discover more about Dr. Turknett's approaches to brain health through music, visit brainjo.academy. His new book "Anyone Can Play Music" is available wherever books are sold.

This blog post is based on a Bionic Health podcast interview. At Bionic Health, we believe in affordable, precision medicine for optimal health, delivered by doctors and AI working together.

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Understanding Your Metabolism: More Than Just Burning Calories

Ever wondered why some people seem to eat whatever they want while others gain weight just looking at food? The answer lies in understanding metabolism - your body's complex system for converting food into energy. Let's break down the science into digestible pieces.

The Building Blocks of Metabolism

Basal Metabolic Rate (BMR)

Think of BMR as your body's pilot light - it's the energy you need just to exist. Even if you spent all day binge-watching your favorite shows without moving, your body would still burn these calories to:

• Keep breathing
• Produce hormones
• Grow and repair cells
• Keep your heart beating

Resting Metabolic Rate (RMR)

RMR is like BMR's close cousin - it measures similar things but under slightly different conditions. The main difference? RMR can be directly or indirectly measured while at rest and is influenced by recent activity and meals. For practical purposes, they're nearly identical (only 10-20% difference).

Your Daily Energy Breakdown

Here's how your body uses energy throughout the day:

BMR: The Heavy Lifter (60-70%)

• The majority of your daily calories go toward basic survival functions
• This is why crash diets that drop below BMR are so dangerous

Thermic Effect of Food (TEF) (10-15%)

• Yes, you burn calories digesting food!
• Different foods require different amounts of energy to process:
  
  • Protein: Burns 20-30% of its calories during digestion
  • Carbs: Burns 5-10%
  • Fats: Burns just 0-3%

Exercise Activity (EAT) (5-10%)

• Calories burned during your workouts
• High-intensity exercise creates a longer "afterburn" effect
• More intense workouts = longer metabolic boost

Non-Exercise Activity (NEAT) (5-10%)

• The fidgeting, thinking, and random movements you do all day
• Can vary significantly between individuals
• Often decreases during dieting (you naturally move less as your body attempts to limit calorie burn, being in a deficit)

Smart Weight Loss: Working With Your Metabolism

Want to lose weight without wrecking your metabolism? Here's the smart approach:

1. Never eat below your BMR - it's like trying to drive a car without enough gas
2. Calculate your target calories:
   Daily Calories = (BMR × Activity Factor) - 250
3. Aim to lose 0.5-1 pounds per week (anything faster usually backfires)

The Calorie Quality Question

Not all calories are created equal. Here's why the type of food matters:

Protein: The Metabolic MVP

• Burns the most calories during digestion
• Increases overall energy expenditure
• Helps preserve muscle during weight loss
• Keeps you feeling fuller, longer

Carbohydrates: Choose Wisely

• Complex carbs require more energy to digest
• Simple sugars are "metabolically lazy" and digest quickly, great for a workout but not at rest
• Quality matters as much as quantity

Fats: Essential but Efficient

• Burn very few calories during digestion
• Important for hormones and health
• A little goes a long way

Practical Takeaways

1. Focus on protein - it's your metabolism's best friend
2. Don't crash diet - it's like putting your metabolism in hibernation and most people gain back all the lost weight and more once they end
3. Stay active - both planned exercise and daily movement matter
4. Choose complex carbs over simple sugars
5. Remember that healthy weight loss is a marathon, not a sprint

Your metabolism isn't just a simple calorie counter - it's a complex system that responds to how you eat and move. By understanding how it works, you can make better choices that support your goals while keeping your body's engine running smoothly.

Remember: The best approach to managing your metabolism is one that you can maintain long-term. Quick fixes might work temporarily, but they often lead to metabolic adaptations that make maintaining weight loss harder in the future.

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Aging Skin & Rejuvenation: Insights from Dr. Jennifer Goldwasser

In a recent Medicine 3.0 episode, Dr. Catherine Isaac welcomed back dermatologist Dr. Jennifer Goldwasser to discuss aging skin and rejuvenation strategies. This informative conversation covered everything from basic skin care to advanced treatments, offering valuable insights for anyone looking to maintain healthy skin as they age.

Understanding Skin Changes with Age

Dr. Goldwasser explains that as we age, our skin undergoes numerous changes:

• Mottled, non-uniform coloration
• Increased laxity
• Development of wrinkles
• Growth of various skin spots

Sun exposure is the primary culprit behind these changes. Dr. Goldwasser suggests comparing protected skin (like the underside of your arm) with frequently exposed areas to see the dramatic difference sun damage causes. Another telling sign of sun damage in elderly individuals is "senile purpura" - red-purple blotches that appear on sun-exposed skin due to deteriorated connective tissue.

The Subtraction-First Approach

Rather than immediately adding products, Dr. Goldwasser advocates for a "subtraction-first" approach to skin care:

1. Eliminate harmful habits:
   • Tobacco use (smoking, vaping)
   • Excessive alcohol consumption
   • Recreational drugs
   • Sun exposure
   • Ultra-processed and animal-based foods
2. Add beneficial practices:
   • Plant-based diet rich in phytonutrients and antioxidants
   • Simple, targeted skin care routine

Essential Skin Care Elements

1. Gentle Cleansing

Dr. Goldwasser recommends gentle cleansers like Dove sensitive skin products or La Roche Posay's hydrating cleanser. She warns against products with strong fragrances, dyes, or exfoliating particles, especially for aging skin which becomes thinner and more sensitive.

2. Proper Moisturizing

• Choose the right vehicle: Creams (oil-based) are better for aging skin than lotions (water-based)
• Look for jar packaging rather than pump tops for richer products
• Recommendations: Vanicream, La Roche-Posay Lipicar, CeraVe or Cetaphil in jars
• For extremely dry areas, Dr. Goldwasser surprisingly recommends Crisco shortening as an effective, non-irritating option

3. Sun Protection

Sun protection remains crucial even as we age, as UV damage continues to accumulate.

Managing Common Skin Conditions

Seborrheic Dermatitis

Often mistaken for dry skin, seborrheic dermatitis (dandruff) requires:

• Regular, vigorous cleansing
• Products containing pyrithione zinc (like Head & Shoulders)
• For facial involvement: washing twice daily, once with anti-dandruff shampoo and once with facial cleanser

Dr. Goldwasser notes that seborrheic dermatitis is common in babies and aging adults, particularly those with neurological conditions like Parkinson's disease or those experiencing immunosuppression.

Anti-Aging Treatments

Over-the-Counter Options

1. Retinols: Derived from vitamin A, these are the most potent OTC anti-aging ingredients
   • Benefits: Reduce fine lines, improve skin texture
   • Limitations: Can be irritating and sun-sensitizing
2. Vitamin C:
   • Benefits: Stimulates collagen production, acts as an antioxidant
   • Limitations: Unstable in formulations, effective products are costly
3. Other Options:
   • Peptides
   • Hyaluronic acid for moisture
   • Niacinamide for inflammation

Prescription Treatments

Tretinoin (prescription retinoid):

• Apply a pea-sized amount at night
• Wait at least 20 minutes after washing
• Avoid sensitive areas (upper eyelids, lips)
• May need to start gradually (every other day) or seasonally
• Most effective for fine lines, less so for deep wrinkles or skin laxity

Professional Procedures

1. Botox:
   • Temporarily paralyzes muscles to reduce expression lines
   • Generally safe with effects lasting 3-4 months
   • Best for forehead lines and "11 lines" between brows
2. Fillers:
   • Typically hyaluronic acid-based (Restylane, Juvederm)
   • Best for deeper lines around the mouth
   • Duration varies based on product
3. Lasers and Energy Devices:
   • Can address pigmentation, visible vessels, and redness
   • Newer technologies like radiofrequency microneedling can stimulate collagen and tighten skin
4. Surgical Options:
   • Most effective for significant laxity
   • Eyelid surgery (blepharoplasty) offers good value and high satisfaction

Emerging Treatments

While Dr. Goldwasser finds radiofrequency microneedling promising, she cautions against jumping on trends without sufficient evidence:

• Red light therapy: Limited scientific support
• Topical estrogen: Insufficient safety and efficacy data

Key Takeaways

1. Protect skin from sun damage at every age
2. Simplify your routine - less is often more
3. Choose products appropriate for your skin's changing needs
4. Adjust skin care seasonally and as you age
5. Consider the risk-benefit ratio before trying trendy treatments

The podcast emphasizes that good skin care requires adapting to our body's changing needs with age, replacing dated routines, and focusing on evidence-based approaches rather than marketing claims.

Timestamps:

‍00:00 - Introduction

‍02:39 - Effects of sun exposure on skin aging

‍05:39 - The subtraction approach to skincare

‍09:01 - Gentle cleansers and proper product selection

‍11:57 - Understanding seborrheic dermatitis

‍16:57 - Menopause and skin changes

‍23:36 - Types of moisturizers and proper application

‍32:21 - Effective skincare ingredients

‍37:14 - Anti-aging ingredients: retinols and vitamin C

‍44:21 - How to properly apply tretinoin

‍53:13 - Benefits of tretinoin for aging skin

‍57:44 - Botox, fillers and other cosmetic procedures

‍1:04:36 - Innovative treatments in dermatology1:12:27 - Conclusion and preview of future episodes