What follows is a transcript for the podcast Neurofeedback - Dr. Andrew Hill - Neuroscience.
Topics within the interview include the following:
- The difference between neurofeedback and biofeedback
- Why normal readings during brain mappings are overrated
- How neurofeedback trains the brain
- Can we objectively measure executive function?
- Neuromodulation or neurofeedback: which is superior?
- Why Andrew is a “suspicious curmudgeon” in the field of biohacking
- What neurofeedback reveals about the brain post COVID
- Combining chemicals that boost brain plasticity with neurofeedback
- What brain maps tell us about cannabis and the brain
Dr. Dan Stickler: Welcome to the Collective Insights podcast. I'm Dr. Dan Stickler, your host for today, and today we're happy to bring back Dr. Andrew Hill to the show. Dr. Hill is the founder of Peak Brain Institute and a top peak performance coach. He holds a PhD in cognitive neuroscience from UCLA's Department of Psychology and continues to spread cognitive research using EEG, QEEG and ERP methodologies. Dr. Hill, welcome back to the show.
Dr. Andrew Hill: Oh, thank you so much for having me back. Nice to see you again.
Dr. Dan Stickler: Yeah, I'm excited to talk to you today. We've been doing a big deep dive into COVID Brain and I want to pick your brain on that one here in a little bit, but your primary modality is neurofeedback, so I really want to give the listeners an overview of what it is and why it's such a powerful tool.
What Exactly is Neurofeedback?
Dr. Andrew Hill: Sure. Happy to chat again about any of this stuff, of course. Neurofeedback as a toolset encompasses a few different things. We often have an assessment tool we use called brain mapping or quantitative EEG in the field, which helps us do that quantified self at the level of brain, the same way we often in biohacker world, we look at our functional medicine, our methylation, our genes, our organic acids and dial in potential models that may impact our wellness and may impact our health, but just like your genes, you don't necessarily know looking at one person's data, what it means for that person discreetly. Most of what we're doing in brain mapping, which is the assessment landscape for neurofeedback, is a population-level tool set of saying, "Hey, here's some differences from average. Let's model what's going on in your brain." The practice of nerurofeedback is the modification and the assessment of the brain we call quantitative EEG.
Let me describe the mapping and then I'll give an example maybe out of what shows up and talk about how we would change it, how it would actually change your brain, because that's the goal with neurofeedback. Not so much diagnostic, from my perspective, but it's focused on getting you to make some transformation longer-term. Brain mapping is basically a cap on your head or individual wires on your head. For those of us who have great haircuts like you and I do, it's really easy to find locations on our head, although you probably had a few EEGs. Just that aside, it's actually kind of hard to get good signals on bald heads, right?
Dr. Dan Stickler: My techs have said that it is harder on bald heads. [inaudible 00:03:40]
Dr. Andrew Hill: Yeah, it really is. People don't believe that because our skin is out in the air, so it thickens up and gets oily and more insulation. The best heads are people with thick, dark hair, for some reason, and the scalp never sees the sun. Anyways, we put a cap on your head and measure your brain at rest with your eyes closed and your eyes open. That's a quantitative EEG or a brain map. And out of that comes population-level differences. Oh, your theta, your alpha, your beta, whatever, are doing something different than average, and people are weird, so good job, be weird. But the things that get in the way are also a little weird. You want to walk through the outliers and try to model what they could be doing, and we also do an attention testing suite alongside that to have two axes to examine your resources, a performance and a physiology.
And Peak Brain's a little bit unlike most of the therapy-focused neurofeedback places in that we don't say, "Here's your diagnosis, let us treat you." But more, "Hey, here's your data. Let's teach you to dig into it and read it and understand the phenomena." Our clients often map a lot throughout the year and have open-ended access to digging into the data, and the stuff that shows up in brain mapping most reliably across people at a high level are the gross resources of stress, sleep, attention, and then you can get a little more granular with speed of processing, and sometimes you can see things like brain fog or other inflammatory things to get a little into that post-COVID brain thing you were mentioning.
The Difference Between Neurofeedback and Biofeedback
Dr. Andrew Hill: You can see these gross features and then often correlate them to performance, especially in executive function performance. If you're a little bit ADHD or you're impulsive or distractable, you tend to see that pretty clearly on a brain map. And then the process of neurofeedback begins, which is a form of what's called biofeedback. People often are a little curious about the difference between biofeedback and neurofeedback, and essentially all neurofeedback is a form of biofeedback. And when people say biofeedback, they usually mean the stuff we did in the '60s and '70s a lot, which is peripheral nervous system-based, including hand warming, galvanic skin, changes with electrodermal biofeedback for relaxation-
Dr. Dan Stickler: Breathwork.
Dr. Andrew Hill: Breathwork, heart rate variability biofeedback, which is resurged in the past 10 or 20 years, is a really approachable modality for getting into training the vagus nerve for controlling physiological balance between activation and relaxation. That's biofeedback, and then when you go after the things for biofeedback that are in the central nervous system, stuff inside bone... That's, by the way, the definition, for folks who are curious, peripheral versus central nervous system. If it's inside of a bone, it's central. If it's outside, it's peripheral. You're somewhat aware of the peripheral, you're not really aware of the central nervous system. It doesn't have any sensory nerve endings inside of it. You can't feel your brain, or the inside of your spine basically. There's nothing in there really to feel, except for the outer layers which have some sensory stuff.
When you look at your brain and you measure it in real time, the process of, let's say brain mapping might show for one person a little outlier, and in going over the description or the digging into what it could mean with them, you might discover something's important. Let me give folks an example. There's a couple of circuits that are really visible when we have a lot of stress. They're called the cingulate cortices and they're in the front and back midline, and their job is to switch your focus around when you need to do things different with your focus. And broadly, might be useful to know that the front of the head is the inside world and the back of the head is the outside world.
The cingulates have a corresponding relationship to switching your focus internally and externally, so the front midline helps you remember what you walked into the store for, and the back midline helps you go, "Oh, watch the road," or, "Heads up, Frisbee," and orient yourself to the important thing to quickly evaluate and orient to. But because the world is not especially safe or predictable, these resources can cramp up or spasm or get overused and become stuck in high gear, and when the one in the back gets stuck, people tend to experience cycling in this evaluation state and orienting to what's important state, and this is not terribly comfortable and tends to produce the experience of rumination, of chewing on things, being a little threat-sensitive, being activated. And the front midline does a similar phenomena, but almost purely cognitive without the worry, so it's perseveration, or obsession basically.
These little circuits, we all have them, they can cramp up and they produce flavors of anxiety basically, when they get really extremely cramped, up the front one produces OCD type stuff, and the back one PTSD type stuff. But we all hyperfocus or select our focus, we all have threat sensitivity and an evaluation orientation, so these are not necessarily problematic. Even when they're very, very acute in things like OCD and PTSD, you don't really have to think about this as a disease. It's not a progressive process. It's not caused by something like an infection. It doesn't have a root cause that if you remove it, things go away. It's a dysregulation of a system closer to a spasmed muscle or a functional imbalance in strength or something. And like a whole system, it tends to train, so now we're into neurofeedback.
Somebody comes in, looked at a brain map, we say, "Whoa, your front midline is kind of hot. You might have a little OCD. Maybe you're a CEO, maybe both. Maybe you're stuck in your head all the time." And if someone identifies that as a goal to go after to change, we would do some training with them, and it might take a few weeks to start experiencing shifts subjectively, and a couple of months to make some permanent changes, but we would do that by, in this example, putting some wires on those cingulates, on the scalp above the cingulate... And it may be an ear clip-on, it's like three wires let's say. And just measure the activation of those modes moment to moment, which is probably going to be like extra beta waves, and also measure the relaxation, the neutral of those modes, alpha, moment to moment. [inaudible 00:09:53].
Dr. Dan Stickler: Now a question that we get asked about this, because-
Dr. Andrew Hill: Yeah.
Dr. Dan Stickler: I'm sorry to interrupt you, but I want to get some clarity for the listeners, because we get asked this question a lot. We're putting an EEG, we're putting electrodes on the surface of the scalp, and the measurement is right underneath where we're doing this. With the cingulate gyrus being a deep midline structure, how are we able to identify that that's where this signal is coming from?
Dr. Andrew Hill: The cingulate is so organized and so powerful that as a particular little circuit doing this job, it's a generator of specific information and the areas right around the cingulate aren't as specific. They're more connected to other regions, so you can see what are called the rich hubs or rich clubs of the cortex through the scalp. You can't see every little bit, but you can see the big gross giant circuits that... Especially ones that interconnect with other ones and do a lot of information flow, you can see the information flow and know the endpoints, if you will. But the cingulates generally stick up when they are uncomfortable. Really easy to see through the scalp. You can also see most of the big circuits involved with auditory processing on both sides. You can see the circuits involved with sensory and social integration, which is a little further back on both sides, pretty clearly. You can see across the top of the head, big circuits involved with executive function and sleep regulation.
Why Normal Readings During Brain Mappings Are Overrated
With that landscape you paint out a lot of the overlapping... You can estimate or model or guess about some of the underlying resources of a couple of, essentially the foundation of sleep, stress and attention, and those three things themselves each share underlying brain resources, so sleep and attention, attention and stress, sleep and stress all share an underlying regulation. With this perspective, you just know what's unusual. This is why we're in the landscape of personal training versus medicine, because it's not diagnostically valid to say, "Aha, your anterior cingulate is running more beta by three standard deviations. That's unusual and therefore it's a problem." That last bit is not true.
Unusual, sure, but does it get in the way for you? Is it interesting? Is it important? It's just like you might look at your lipid panel and for some people having one aspect of lipid panel is really concerning. For somebody else it's fine because let's say your LDLs a little high. It's really a problem if your triglycerides and BDL are also high, but otherwise... Maybe you're a carnivore, eats no carbs, and LDLs a little high, but this is no triglycerides, no BDL, then you wouldn't be concerned about the LDL being a little high. Same thing with the brain map. If you're a little bit of anterior cingulate but you use it successfully, if your thoughts aren't having you, great, then you're a hyper-focused Steve Jobs type and you're not a little bit obsessive. You're not [inaudible 00:12:49].
Dr. Dan Stickler: I was going to say, we've had this conversation before. I think when we were in London we talked about it, because we also evaluate based on performance issues, and the problem is all of the comparative databases are based on normative brains. And so if you go to a standard neurofeedback clinic or neuromodulation clinic, you're going to go in there and they're going to say, "Oh, you're two standard deviations away from normal," but it may be the gift of these high performers that we work with, and you take that out and they lose that talent that they had.
Dr. Andrew Hill: Sure. Well, no one's trying... Well, in the practice of neurofeedback, nobody good is trying to train you to become average. That is not the goal. We don't train to data, we train towards performance, so we always do attention testing alongside it, and then we approach things that are goal-driven. Let me give you an example of why you wouldn't just train the data. On the left hand side of the brain, there's a circuit involved with maintaining the mode you're in. It tends to fall over a little bit when we get spacey, like ADD stuff, but also when we can't maintain our deep sleep, sleep maintenance issues, we have fractured sleep. And the same kind of phenomena produce people that can't do boring things like reading or their mind starts to wander and do something else. It's a kind of management of the mode without the stimulus needing to be maintained kind of thing.
When you see it on a brain map, a lot of the time you see extra beta waves there, and the person has some generalized anxiety and some sleep maintenance issues as a classic sort of phenomenon. Extra beta, left side, maybe the middle a little bit. And so if this is true, the way that I would then go after it to make the change for that person to get them sleeping deeply would actually be to train the beta up on the left side of their brain. I'm not training to the mean. For them, I'm training for their goal using the database, using the yardstick, the somewhat arbitrary yardstick of a QEEG database as some measurement against them so I can then have something to look at. And yes, it's true that high performers have outlying features. When you're doing brain mapping, you don't assume an outlier is a problem, first of all, like I was saying earlier.
But second, the stuff that's in the way is usually an outlier for people, so you don't want to assume difference is a problem, but you also want to look at difference first to figure out if there's plausibility. When I talk to clients, I'm not saying, "Hey, I'm not going to tell you what's true for you." I'm going to say, "Here's a real feature in your data," and then I'll describe what's plausible across people. If what I'm telling you is in the landscape of meaningful, you'll understand that, you'll know it already, so brain mapping shouldn't really tell you things about yourself that you don't really understand. Those aren't the valid low hanging fruit you can go after. And then there's this other inflection that when you do repetitive brain mapping, Peak Brain has a policy of we do free brain maps for a year with our club memberships, so folks just map and map and map and examine their nootropics and their post-COVID and everything else that they do.
But the maps within one person start to get really meaningful because you can correlate what the person's been doing with their transformation, neurofeedback or otherwise, or injuries, whatever, correlate performance changes, correlate brain changes, so we often encourage folks when they first start with this now to do what we call contrast mapping. If they have things in their lifestyle they really enjoy, like caffeine or Adderall, cannabis or nootropics or whatever, we have them do a couple of maps early on because I can teach you more about your brain, brain mapping and your substance of choice with that kind of contrast to data points, because it really rings true for you as the person seeing the consistency, seeing the subtle changes that you know how they feel. Brain mapping is a tool of exploration, not a tool that's like, "Why aren't you average?" It's great. Good job.
But the classic anxiety features, the cingulates, the social and sensory areas, that kind of stuff, they show up pretty clearly. You can see motivation stuff. You can see the classic diseases of aging and big injuries, the frontal temporal stuff, you can see all the big stuff that people struggle with neurologically generally. You can see seizure disorders when they're active, you can see the consequence of seizure disorders when they're not, like the deep fatigue stuff, which looks like apnea essentially. You get these gross reads on people's performance, physiology and performance, and then we construct neurofeedback. To make the change, let's actually start with that sleep maintenance and ADD thing, because it's easy, beta left. Too much beta... Sorry, too much alpha is ADD or spaciness in the left. Bringing up the beta means you can hyperfocus and laserlike focus if you want to, so people often love the left side beta training.
How Neurofeedback Trains the Brain
Dr. Andrew Hill: You measure the brainwaves you're making moment to moment on your own in neurofeedback, in most flavors. There's different, of course, styles as you know, but in classic neurofeedback it's passive and sees measure what your brain is making. And then whenever your brain happens to make a little more beta, let's say, or a bit less alpha, let's say, for half a second, the computer goes, "Ooh, good job brain." And starts to applaud you with audio and visual feedback. And the brain's like, "Hey, stuff's happening when I'm raising my beta. That's kind of cool." It has no idea this is not some random musical instrument you're trying to learn or some new car you're trying to learn to drive. It's like, "Hey, wait, stuff in the outside world seems to be responding to me. Okay." Within five minutes, the brain is actually picking up the neurofeedback response.
That was my dissertation work actually, was doing a double-blind placebo-controlled study of neurofeedback with a 64 channel cap on top of it, looking at the evoke potential, trying to figure out how the brain was actually starting to notice the neurofeedback, like when it happened, how it was happening. In about five minutes, your very first session, the brain's like, "Hey, wait. What? Oh, okay, that's being applauded. I'm going to react in that frequency." And then the big trick of neurofeedback for folks that are interested in the actual mechanism is we move the goal posts, we adjust what we're asking for, so it's involuntary because you can't control your brain waves, they're fluctuating. When they happen to trend a little bit up or down in the desired direction for that particular workout, the computer applauds you with a little game in the screen moving or some audio happening or something occurring.
And then when the brain moves in the, quote unquote, wrong direction for that workout, the audio slows down, the little car slows down, the PacMan stops eating dots, something decreases and the brain starts to notice that of the billions of things it's doing, one of the very, very narrow, a few different frequencies or a few different bands of amplitude, or a couple different communication paths for information flow, are the thing that are being applauded. And it goes, "Huh, that's interesting." And people usually about three or four sessions into their first neurofeedback experience will have a subjective experience about... Not right away usually, because the brain doesn't change rapidly, but somewhere around three, four sessions in the brain says, "Oh, okay. I'm getting more information as I bring the beta up there. I'm going to do that now." And you're like, "Ooh, I feel kind of... That's interesting. Do I... Yeah. No, I kind of feel something."
And it's kind of this lingering background experience initially, and then you get a little flex every time you exercise the brain, do a little half hour of neurofeedback, you get a little flex for the next day or so in the thing you train, but also in the gross resources of stress, sleep and attention. That's the trick. You want to watch the things as they unfold the next day to grade the stuff you just did. Did you get some anti-anxiety effect? Great, but how is your sleep? Oh, I felt super chill, but I couldn't fall asleep last night. I was waking up. Oh okay, let's add some stuff in there. You want to work the whole system out, not just work on the symptom. You can't just do hotspotology, as one of the leaders in the field who does source analysis, Pascal Marquis, disparagingly calls some old school neurofeedback, hotspotology, where we're sort of neo-phrenologists saying, "This spot does this." And then you work that way.
Brain doesn't work that way and people are different. If you and I had the exact same 10,000 foot brain map and had exact same complaints and tried the exact same neurofeedback protocols, we would have different effects. Just like two guys who look the same in the gym might have really different effects sitting on the same machine or trying the same workout or something. Just systems are different, and brains are more different than bodies, so it's a little bit more of an iterative approach. But starting about three, four sessions in, the brain starts to produce a little lingering effect, and then you get to burgeon that effect by doing more of the same neurofeedback. Peak Brain maps the brain every other month or so when we're doing training, and we like to do two rounds of that to get to a permanent change for things like attention, stress, sleep, the basics.
Stop drinking too much, give seizures a certain amount of control. That's a chunk of neurofeedback, a big dose, so to speak, is about 40 to 50 sessions and that tends to produce a lot of change, so we map every other month, every 20, 25 sessions at our office, and we end up getting something in the neighborhood, for most people, something in the neighborhood of one standard deviation of change on their attention testing and their brain mapping every other month. Whether or not you come in for ADHD, you generally have some attention difficulty if you have stress or sleep or trauma or something else, your attention takes a hit.00:21:58 Executive function is an expensive thing, a very high level human thing, and you see it pinch up when your sleep is crappy or your stress response is dysregulated.
The executive function tends to also dysregulate, so we see brain mapping, like the cingulates, let's say in trauma or OCD, and we see the performance being a little off, and those things all shift by about, on a bell curve, about a standard deviation as you go with this style of neurofeedback. Of course, there's different styles, but this classic style is really reproducible across people and that's why I tend to use it.00:22:30 It's also a very low side effect, just the form that I use.
Dr. Dan Stickler: Yeah. Do you do any objective measures of improvement in executive function or cognition?
Can We Objectively Measure Executive Function?
Dr. Andrew Hill: We do. We use an executive function test called the IVA, which is a classic CPT, a continuous performance task that just bores you to tears. All the CPTs that are well validated essentially work the same and they all correlate really strongly with each other. And folks may have heard of names like the IVA, the TOBA, the Connors, and all they're doing is flashing stuff or speaking stuff every so often and requiring you to respond to some things and not respond to other things. This is often called a go, no-go test, for instance, and we do a 20 minute really boring attention test. We flash a one or two on the screen or we speak it over the speakers. The only job is to click the mouse for the one and not click for the two. But you start to brown out and slow down, maybe miss a one, maybe get reactive and click on a two, and we can tease apart the executive function in about 14 different little variables that are much more granular than something called ADHD.
Because I'm looking at your stamina and the carefulness ability and the auditory versus the visual, and the trends across time versus the transient resources, and you can really break down what's happening in the executive function that way. And these tests have almost no practice effect. They're a little sensitive to fatigue and stress and they pick up a little variability of your day, but you can't get better at them by doing them more, so they're great tests to do executive function-wise and they correlate very, very strongly with some of the big executive function things we see in the brain maps, so if you have a classic ADHD performance, and it comes from ADHD style stuff, which it doesn't always in the brain, but a lot of times it does, and you go look at a brain map, you see high amounts of theta and impulsivity and distractibility, you see high amounts of alpha with the eyes open and inattention or spaciness.
And this is true in a classic below 18-year-old population whose diagnosis is ADHD. The theta-beta ratio is above 90, it's like 94% specific for picking out ADHD. It's a very robust phenomena. And then you can see alpha is also about 80% accurate. That was research done by Vince Manastra 20, 30 years ago, and it was really, really robust and several people replicated it right away. It was just this big thing in the field, and then every couple of years, some grad student would try to replicate that study, and they replicated it, but every year the statistic got a little weaker for the next 15 years.
And there's a great in the field of neurofeedback, I'm sure you know Jay Gunkleman, he was lecturing a couple years ago at a conference and he pulled up all this data from several of these studies and then he pulled up a bunch of data looking at kids' sleeping habits in this country across the exact same time, and what we demonstrated was that we're losing the sensitivity to spot ADHD in the brain mapping because sleep disruption was so rampant in the adolescent population, teen population, that it started to look exactly the same. Chronic sleep depth in a resting brain has very similar features to some extent, at least in the teen brains, adolescent brains, to what ADHD looks like. Word to get your kids to sleep.
Dr. Dan Stickler: Yeah, we've seen a lot of that where these kids get put on the ADHD medications and their performance will be good for about two years on it, and then all of a sudden they're back to exactly where they were taking the medication even, so we've had better results with neurofeedback and neuromodulation. And that's a question I have. We've shifted a lot more towards neuromodulation from neurofeedback. Can you give some insights on your perspective on that?
Neuromodulation or Neurofeedback: Which is Superior?
Dr. Andrew Hill: On neuromod versus neurofeedback?
Dr. Dan Stickler: Yeah.
Dr. Andrew Hill: Yeah. I don't use any neuromodulation, not because I don't think it works, but there's a... The positioning, if you will, of what I do and what Peak Brain does, I'm a scientist and a coach. You're a doctor. I have a PhD. I'm not a real doctor. There are PhDs who are real doctors that they have licensure, they're clinicians, and there's MDs who are all real doctors, and then there's PhD, some of which are mad scientists and academics, and I'm more in that landscape, but I'm an applied scientist for clients, so I end up being a coach as we do neurofeedback, educator and a scientist as we do brain mapping. I've worked in every possible clinical environment you can imagine over the past 30 plus years, and I have a deep, deep clinical experience working in crisis, addiction, autism, all kinds of things that are very, very clinical, but as I got into neurofeedback before grad school, I started being blown away by the transformation, I'm sure you were too when you first started seeing what it could do.
Just magical transformation often, and things that other stuff doesn't change to some extent. And what I found was as I got good at brain mapping and talking to people about the process of what was happening in their brain, it created almost as much benefit as the transformation they got from neurofeedback. The agency that you... If you see your anterior cingulate as crampy, and I can say, "Hey, that's a thing that shows up when you're a high powered CEO," or if you have a little OCD, they can go, "Oh, okay. Yeah, yeah. Cool. Superpower, kryptonite. Nice. Okay, get some control over that." And it's not a disease, now it's like a quirk, it's a strength that's gotten a little dysregulated.
And if you show people their brains and talk about what's going on, it creates this opportunity for a lot of things that used to be really sort of shame-filled and I was concerned about, I feel like I'm failing at, you can now be frustrated at your metaphorically spasmed shoulder or broken bone you see on an x-ray, but you're not going to be ashamed of your broken bone, probably. And seeing the realness of it, people tend to reshuffle the relationship with this stuff 00:28:31 and then it gets you to take control of it over time. The interventions that I'm working with, I'm working with across people, across intervention, acute clinical stuff sometimes, but often peak performers, often everything in between. At some of the centers I've worked out, I have used things like TMS and tDCS and other techniques like that, I've used light and sound work, I've used all kinds of Magstim. Historically, I used to use the old Roche machines back when they were active years ago.
I've used every platform pretty much that exists in the landscape for neurofeedback that is both passive and active, so to speak, or the stim versions. I never found efficacy to be any greater for the things that I tend to work on across people with a neuroma that I've had access to over the past 20, 30 years. And then as I moved out into being my own entrepreneur and company builder and coach, the side of things I fall down on are the non-invasive things. It's a lot harder to screw somebody up with traditional neurofeedback than it is with badly placed neuromodulation. You can do more harm more quickly. Neurofeedback if you do the wrong protocol, if it's not well suited for you, if the wire's too far away from where it should be, etc., you don't get the right effect. You get a little side effect.
And then if you don't repeat the protocol that way, the brain goes back to where it was the next day, so you have this opportunity to push things up and try stuff and irritate the system and enjoy it and play with it. Personal training. And in that landscape, I haven't found some of the tools to be especially reliable in my history, but I haven't built in the things that require that deep treatment focus, which is a medical perspective, requires expertise and treatment. I've kept it in a training landscape where if I teach people about their brains, about their neurofeedback, about the approach and they take control, then it keeps people having the agency, which is very important to me, but it also keeps my company and Peak Brain in the role of coaches and doesn't replicate the failure of neurofeedback to grow as an industry.
This thing's been around for 55 years. Older than I am, and it's nascent still, the industry. It's got 5,000, 6,000 people in the US, it shrunk over the pandemic. People are aging out and dying in the field. People that invented this and discovered this are still alive. Some of the second generation who learned this are not, because they've aged out of the process, so to speak, so we're still in this really weird black art, lots of competing tools, lots of fringy science out there. And I don't like all the neurofeedback that's out there. I think some of it is less effective or misses the point, or misses the impact, or is too expensive. In the biohacker world... My hunch is you're in the same position a little bit, but there's lots of interventions that are exciting, there's lots of things that cause impact, and there's lots of stuff out there that's nonsense.
Why Andrew Hill Is a “Suspicious Curmudgeon” in the Field of Biohacking
And some of the nonsense we don't know yet is nonsense, some that we do. I position myself a little bit as a suspicious curmudgeon in the field of biohacking. I don't want you to grab for the magical next thing. I want you to go after stuff that has been around for a few years, has almost no side effects. I really want a hew to the nootropic definition tightly, which is no side effects, very little downside, etc., in all the interventions I use, because at least half my clients are extremely either high performers or squeezing up performance somehow. And risking downsides for folks that don't have severe things they're trying to quickly change, it doesn't make sense to me to risk any downside, so this is why I never recommend people do research chemical nootropics. I'm like, "No, no, no. You want to do all the ones have been around for 5, 10, 15, 20 years, have tons of human research."
Don't use this stuff that has only been tested in mice and was dropped by some pharma company because of the tumor studies that showed up. Don't use that stuff and don't use the stuff you get from Russia or China that has lead in it and has semi-addictive properties and stuff like that. I tend to be a little bit like... Not dismissive, but I guard the toolsets we recommend, and I recommend a lot of the basic stuff, and biofeedback in the body, HRV for instance, meditation, lot of sleep hacking, a lot of neurofeedback using brain mapping-driven stuff. We also do a lot of HEG neurofeedback, which is in blood flow training. That's hugely impactful by the way, on post-COVID brains because it's vascular training. And then the other piece of it that I tend to bring in is metabolic biohacking.
I teach people about the ways to partition energy and control the circadian system, as well as your internal energy sensitivities, energy flux. I believe that a failure of energy flux is behind a lot of the root of aging and illness. I think energy flux is going to be the new inflammation. 10 years ago, 20 years ago, everything's inflammation. I think now it's all going to be about resistance to the energy levels, insulin resistance, hyper insulinemia or high blood sugar, we now know that a lot of the post-COVID brain fog stuff, a lot of the post-COVID brain... there's a study out yesterday suggesting it's way more prevalent than we may have thought it was, but a lot of it seems to be driven by having underlying inflammatory, clotting cascade or some other systematic problem that is a metabolic issue to some extent, or a natural variant for you.
I have a, for instance, just to share personally, I have a lot of liden factor five, both personally and in my family. There's a huge amount of liden five, which is a clotting difference. And people clot way too easily, essentially, and if you're women, you tend have a lot of miscarriages. Surgeries are often complicated. And my family's had a lot of problems with COVID for several generations that were older because of the liden five. Not much you can do about that, but I think we're starting to see that people that get hit with COVID harder, that have more long COVID, it's the same set of risk factors for accelerated aging, for metabolic dysfunction. There's a big driver. Alzheimer's for instance, is a type three sugar dysregulation diabetes in the brain with oxidative stress, but I think if you have that hyperinsulinemia or you have the inflammatory cascade of lots of adipose load, I believe that's what's driving the incidence of long COVID to be quite high. My hunch is-
What Neurofeedback Reveals About the Brain Post COVID
Dr. Dan Stickler: I've seen a lot in our practice because we map all of our clients every year, so we had a nice visualization of the way their brain changes occurred after COVID, and they had symptomatology associated with it even when they had mild COVID. And then getting their brain, it was nice to have that pre-COVID baseline of their brain where we could actually see what was happening and we could work with them through neuromodulation, neurofeedback to get them back to that beautiful baseline that they had. But it's interesting, the data. We started seeing this early last year, and then the data started coming out of the impact of COVID on the brain, and it's scary. What was it? There's a 0.3% volume reduction even with mild COVID that they found. That is-
Dr. Andrew Hill: That's equivalent with Alzheimer's and age-related brain... 3% is age-related brain volume decline.
Dr. Dan Stickler: Yeah, and they were predicting a tsunami of dimension in 20 years based on the fact that everybody's aged so quickly in the brain from this.
Dr. Andrew Hill: Yeah, it's kind of like everyone joined the NFL for four years and played rough essentially, is what it seems to be. Same thing, I have 1,000s and 1,000s of clients before COVID, many have come back unfortunately to check their brain out after COVID with COVID, post-COVID. So much of it's... It's not all perfectly consistent, but a lot of it is. 70%, 80% of what I'm seeing is very consistent in terms of... Looks very concussive, looks like they may have had some sort of inflammatory insult. Often lots of delta on both sides of the head. Of course, that's not really about the localization. It might be because of old concussions. I do see old... I see new COVID impacting old injuries and I know we're there, I see it blowing up inflammation, but I also see temporal lobe delta signatures in a lot of people.
Usually it's low power right after COVID and high power later on, and I think what's going on is the big blood vessels of course that feed a lot of the brain come up through there, and I believe the brain tissue itself must regulate some of the metabolic draw through those blood vessels, so we're seeing less of a global demand of fuel in the local temporal lobe, big blood vessels and the tissue around them is looking sleepy because of it. I think what's happening. But it looks very much like somebody who's gotten a brand new concussion or has gotten really thrown off and they stopped using a CPAP, their apnea is back hardcore or they've gotten a mild poisoning or a mild drowning or something. Not mild drowning, but it's that kind of thing. It's a metabolic hit.
Dr. Dan Stickler: Have you seen a lot of the blood flow changes with the HEG analysis pre and post-COVID?
Dr. Andrew Hill: The HEG I use as an intervention, not as an imaging tool. I just use a passive camera to measure the heat eflux, the outflow of the brain and then people concentrate and they do vascular training that way. I find that it's impactful to change it and then you end up changing the brain maps pretty well. You change them faster than with just doing the EEG training. I also tend to have a lot of people, depending on their access to resources and facilities, I have them stack in hyperbaric if they're doing post-COVID remediation. I treat it like a post-concussion protocol and I bring usually a hyperbaric center or two online in their neighborhood, I find someone to work with and we stack the two interventions, although you got to be kind of careful because they can stack oddly with neurofeedback and hyperbaric medicine.
Dr. Dan Stickler: Do you use the hard chambers for the hyperbaric [inaudible 00:39:05].
Dr. Andrew Hill: Only. Yes. Only, actually, and I... Again, curmudgeon in the biohacker world, I'm not a big fan of soft chambers in general.
Dr. Dan Stickler: Right, me either.
Dr. Andrew Hill: One of our research guys in-house is working now on a study looking at the impacts of pressure levels, so we're going to try to put some stake in the ground, get some answer to this, but what I see and what I understand about the landscape and how I use it, which is sort of the important part for me anyways, is I use two atmospheres whenever possible. I recommend two atmospheres whenever possible. And I recommend for post-COVID, protocol, five days a week, two weeks in a row, 90 minute dives, pure oxygen, high flow, 10, 20 PPMs. Two atmospheres. At that level you're getting up in the 500% to 600% oxygen saturation. You're getting into that acute anti-inflammatory effect which people are looking for. You're also getting, when you pulse it several days in a row, the hermetic stress that causes anti-aging and stem cell release and telomere lengthening, so there's a bunch of reasons to do it, but I find people get an initial resetting sometimes.
Not everyone has access to it, and so when those things aren't true, I can bring the HEG in and it seems to work as well, if not sometimes better than the hyperbaric medicine because it's focused on the tissue. It's bringing oxidation to a local region. And I also focus, do sort of old school '80s bodybuilder diets. Vince Grandes style steak and eggs for six weeks and going no carbs. I'm not a keto guy, high fat, I'm a protein-focused biohacker where I'm like get protein first, get the satiety, get the signaling, trip mTOR, drop carbs to basically nothing for six weeks and keep your fat, half your proteins to avoid... I don't want you... Ketones in your blood, ketones you're generating from digestion, I'm less excited about for this. I'm much more excited about doing downstream ketosis, which essentially you can't measure in your blood. Well, you can but it's not really stable, so you want to measure things like breath.
I use the Biosense device to measure ketones in the breath. And after a few days of no carbs, you blow off ketones, the acetone in your breath, and after three weeks of hanging out there, you end up starting to use ketones really nicely, and ketones work to do really lovely things, anti-inflammatory things, they repair tissue. The ketones actually go through the brain cells and replace molecules in the cell membranes like those Japanese Kintsugi bowls. You break the bowl and make a nice new bowl with gold repair, and it's nicer... The gold's nicer than the clay was. That's what happened.
Dr. Dan Stickler: [inaudible 00:41:42].
Dr. Andrew Hill: Yeah, exactly. The ketones are oxidative, really resistant structural machinery, not just fuel, ut they're used as fuel. They're also used as structural repair that is really resistant to being degraded in the future, so six weeks hardcore carnivore diets, protein-focused as your core macro, keeping your carbs very low and your fat moderate is a... That plus oxygen of some sort, breath work, hot and cold contrast creates oxygenation, ATG, hyperbaric, some neurofeedback. Those are all my tools for addressing this stuff.
Dr. Dan Stickler: Do you have any experience or knowledge with NIRS, the near-infrared?
Dr. Andrew Hill: Sure. I've used it with imaging. Right when it was first really getting developed, we got a device sent to us from a Japanese lab at UCLA when I was there. We did some imaging with it and I was actually doing... It's interesting, because the imaging is not as sophisticated or as precise as I expected it to be. It's a bit of a coarse phenomena. There's also a... In HEG, in the toolset there's two forms. There's an NIR form and it's a PIR, a near-infrared and a passive infrared. And NIR is an emitter, it sends infrared light out and then the biofeedback device has a receiver to measure the change in red levels, and that's an oxygen nation proxy. I don't find that one to be super impactful. I use the passive infrared. It measures like the big giant heat coming off your brain. PIR HEG was invented by a guy named Jeff Carmen, for folks that are curious.
For me, the tool of NIRS imaging is an imaging tool, and I'm getting into the imaging in that depth, I don't love metabolic imaging because it's hard to do cognitive neuroscience because of the transient events. For me, metabolic imaging isn't that exciting, so that's why I'm not into SPECT either, like Dr. Aman is. It's metabolic imaging. It doesn't pick up the transient stuff, the mechanisms, necessarily picks up global regional stuff instead. And for me, the brain mapping, the QEEQ, the EEG is sufficient to some extent to pick up what people care about. NIRS is expensive as a device, and I find it kind of like SPECT where if you are Dr. Aman or someone who works in the Amen Center who's very heavily trained, then you can read SPECT, but if you're not, you can't.
But QEEG, any neurologist, any neuroscientist, anyone who's been trained to do it has a set of the same resources to start from because you have a population mean kind of comparison, and we know what EEG is, so for me, it's operating in a much more accessible landscape in the neuroscience, and then I'm often in the job of trying to transfer that knowledge. Instead of creating transference where we create a little container and then you get to work through your psychology, I thrust agency back up on you by teaching you your own neuroscience.
Combining Chemicals That Boost Brain Plasticity With Neurofeedback
Dr. Dan Stickler: I want to go back to something you said about the nootropics and research chemicals. I am kind of the mad scientist in the medical community, I think, so I test a lot of things on myself, and a lot of these research chemicals are... Actually have some pretty good data behind them, some good research. They're actually approved in some countries, if not ours. Things like Piracetam and Noopept. They-
Dr. Andrew Hill: Sure. Well, racetams are pretty safe, and when you get into peptides, I think the landscape is getting well established. You used a lot of peptides, I believe, right?
Dr. Dan Stickler: Yeah.
Dr. Andrew Hill: And that's well understood. I'm talking about the metabolic biohacker peptides like Cardarine and things people are out there taking that are potentially pro-cancer and potentially... I'm not even a big fan of... A lot of my biohacker friends take metformin to delay aging, and I don't think that's necessarily established as safe yet to manipulate [inaudible 00:45:43].
Dr. Dan Stickler: Until the [inaudible 00:45:44] study completes, which hopefully will be soon.
Dr. Andrew Hill: But again, I'm conservative here. I want to take an approach of if there's a problem, then you introduce risk. If there's not a problem, you go after things, and I would... If someone's like, "I want to try peptides," I've had clients like this, I've sent clients to you. Oh, go see Dr. Dan, because he knows. Seriously I've done that. And oh, I don't know, but you're interested in that? And I keep... You want to do that? Okay, here's someone to go talk to. That's their expertise. I'm happy to chaperone or quarterbacks people's goals sometimes, but I don't want to be introducing risk for clients in a coaching [inaudible 00:46:25].
Dr. Dan Stickler: Right, and especially in the coaching world. Suddenly you gets slapped with this practicing medicine without a license-
Dr. Andrew Hill: Exactly. I don't want to... I'm extra sensitive to not cross that line. I don't have the... It's somebody's freedom to... Good doctors are out there at the edge of research and science figuring out what in the research landscape is worth translating into practice. That is the role of a translational practitioner. You.
Dr. Dan Stickler: I've seen a lot of these new research studies, particularly the... We met with the University of Texas' new psychedelic research division.
Dr. Andrew Hill: Oh cool.
Dr. Dan Stickler: And they were interested because we had discovered that using ketamine nasal spray prior to doing interventions with the neurofeedback or neuromodulation, we really accelerated the process. We don't know if it's related to an increase in neuroplasticity, a disruption of the default mode network. What is actually happening there, but-
Dr. Andrew Hill: Oh, probably. Yeah. Yeah. Yeah. Interesting.
Dr. Dan Stickler: Yeah. But it's [inaudible 00:47:29].
Dr. Andrew Hill: That's ketamine? Is that what you're using?
Dr. Dan Stickler: Yeah.
Dr. Andrew Hill: It's the esketamine? Interesting.
Dr. Dan Stickler: Yeah.
Dr. Andrew Hill: I've had some clients do ketamine infusions, of course. I've had a few recently get into the esketamine as a tool, and it seems to be rather exciting what's happening there, so that's really cool. That is [inaudible 00:47:48].
Dr. Dan Stickler: amazing. Psychedelics are looking really good too with some of the adjuncts to the neurofeedback and neuromodulation, for sure.
Dr. Andrew Hill: And that's a massive plasticity boost anyways. I find anything you add to neurofeedback that boosts plasticity interacts with neurofeedback. And neurofeedback itself, one single session has been shown to dramatically increase plasticity for 24 hours in the tissue. There's some really good research on that, looking at the threshold of firing of tissue after a single session. I still think though, both of us are operating a landscape that is partially art-
Dr. Dan Stickler: Yes. [inaudible 00:48:29].
Dr. Andrew Hill: ... and there's a certain amount of risk tolerance and decision making and expertise that's brought to bear. You're doing it as a doctor and I'm doing it as a coach, and we happen to have an overlapping toolset, and the places where they don't overlap, I would assume are places where we're getting a little more specialized. But if I had needs where research chemicals or other things involved, I would be consulting with someone like you. I wouldn't avoid them, but when someone asks me how they fix their brain fog, their trauma, their ADHD, their seizures, their migraines, I have reliable solutions for almost everything people come at me with, without needing to reach for those landscapes, generally.
Dr. Dan Stickler: Yeah. No, and I'm sure you have the people like me though, that they come in doing something that is not really recommended by us-
Dr. Andrew Hill: Yes. All the time. Yeah.
Dr. Dan Stickler: ... but we actually will test them and actually see what's happening with them for their purposes.
Dr. Andrew Hill: Absolutely. I'm here in southern California. We of course have offices, a few of them in the country, New York City and St. Louis are not quite as permissive with... Although I guess New York is now with cannabis, but not Missouri, but I can tell you the number of maps I have from individuals where I have a clean, a caffeine, a cannabis, an Adderall or something, a little four set, so I've learned more about what cannabis does to the brain, Adderall does to the brain, COVID does to the brain simply by working with individuals.
How Does Cannabis Affect the Brain?
Dr. Dan Stickler: Let me ask you this with cannabis. We're seeing very negative impacts with the brain.
Dr. Andrew Hill: Yeah.
Dr. Dan Stickler: Are you seeing a similar trend with that?
Dr. Andrew Hill: When you say negative impacts in the brain, I don't see any negative impacts with chronic users that I would attribute to cannabis, no. But I do see-
Dr. Dan Stickler: Okay. We're seeing a global slowing of the resting alpha.
Dr. Andrew Hill: I see that when there's cannabis in their system. I don't see it when they've washed out.
Dr. Dan Stickler: Okay. Oh, okay.
Dr. Andrew Hill: I also see some people who are long-term users, like very long term. I've had a couple people do this as little experiments, like a magazine sent them in, they did little experiment, like a cannabis magazine, and they washed out for two weeks to have a completely... Because cannabis, no one tells people this by the way, cannabis only has an active half life, elimination half life of an hour, hour and a half. People think of cannabis as many days because that's the thing people test for, not the actual cannabinoid, the psychoactive. If you're a regular user of cannabis and you measure someone's brain 48 hours without cannabis, there's really no nothing visible anymore. The brain load is back to baseline. But there's an adaptation to chronic cannabis use. It's not really addictive, but it is sort of adapting, and you need about four or five weeks to adapt back.
I've had chronic users come in six weeks, eight weeks after, I've been sober for six, eight weeks, kind of weird. And then we map their brain, they get stoned, mapped their brain again, do performance testing, both conditions, etc. And they're better when they're high. The brain looks better, performance is better. Some people, it's not just an adulterant, it's self-medicating, I think. I don't understand exactly what's happening. Some folks' brains look jacked up on caffeine and worse, some look better. That's a kind of thing, but I've done 100s of people's brain maps with and without cannabis, like active cannabis in their system real, like they alter their brains and remap in real time. Every single time... Well, 99% of the time, performance takes a dramatic hit. 99% of the time you see that increased slow brainwave stuff, you see alpha slowing down, which is... That's why motivation tanks, by the way, alpha's your speed of processing, so if your alpha slows down with weed, it's like driving your car with the emergency brake stuck a little bit. You're like, "Too much work.
But these same people, I have worked with... Again, Southern California, I meet a lot of them, but people that are lifelong users, I don't see any real impact long-term. Interesting. And I think that, and I've been asked this question a lot by parents, I've been asked this question a lot by my students when I taught at UCLA for a long time about cannabis. And I've dug into the research and I think that my take on this is, how weed affects you is a lot more impacted by other aspects of your life, especially socioeconomic status, previous health status, previous nutrition status. Doesn't seem to be about the weed so much, with one exception, that if you have any of the genes or family predisposition to the bipolar schizophrenic stuff, stay the heck away from weed, because it seems to potentiate that. But barring that, as long as your brain's finished developing, you're essentially young adult or above, I don't have any real…
I'm sort of agnostic to cannabis because it's such a giant... As of three days ago, even Joe Biden's talking about it, so there's a sea change obviously in this country with regards to it, and I don't think it's a unilaterally good thing either. I treat cannabis, and people ask me about it, just like food or sex or television or anything else that is rewarding that we interact with. You probably don't want to abstain from food or TV or sex, or you can, but you don't have to... You can't do it from food. Well, anything that's rewarding, we have to have a relationship with that's healthy, and I really do think that humans have been altering brains since before we've really had them in this format. Birds will look for fermented fruit juice and get drunk and stuff. We're very excited by altering our mammal brains. I don't think there's anything wrong with-
Dr. Dan Stickler: We're ecstasis junkies.
Dr. Andrew Hill: Yeah, exactly. And we do ecstatic work and we dance and we sing and we feel love and we have passion and anger, and we like the intensity and the experience and it means something to us. We have a personal experience with it. I'm a big fan of that. A big fan of having personal experiences across the landscape, but when you get dysregulated, that's when I get very concerned. That's when I'm showing someone that their cannabis use is jacking up their anxiety markers, making their ADHD go up by three and increasing their reaction time, but making them super error prone or something, so it's all educational that I figure out how this stuff works.
Dr. Dan Stickler: Well, Andrew, as usual, I could talk to you for hours about this stuff, but I know you have a schedule, as well as myself.
Dr. Andrew Hill: That's right.
Dr. Dan Stickler: How can listeners get in touch with Peak Brain Institute to get involved?
Dr. Andrew Hill: Yeah. We have some physical offices in New York City, L.A., St. Louis and also Orange County, California. About three quarters of our clients work with us without ever visiting an office now. Most of our programs are remote. We can send you gear, do brain mapping with you, doing our feedback with you without coming to the office, so just check us out at peakbraininstitute.com, or most of our socials are Peak Brain L.A, because that was our first office. And check us out, ask us your brain questions. We have some free mindfulness groups online that are continuous, and then you can get into the discount brain mapping program. All of our podcasts, whenever I do a guest spot, we discount the club membership, so folks want to come in and get their brain mapped, they have a year of access. A nice, really lowest rate, best deal in the country for brain mapping, so we'll churn all the-
Dr. Dan Stickler: I can tell you, having regular brain maps is... It's as important as going for your annual checkups with a physician. That annual brain map is so key to really understanding changes and catching them early before they can [inaudible 00:56:19].
Dr. Andrew Hill: And not just problems. When you understand how you work, you can then... If I see that your delta waves and alpha waves are off in speed, I'll maybe tell you about a couple circadian tricks and then you dial them in, check it later. Hey, I feel better. Mouth speed's back. Yeah. I have a lot of parents give their kids sleep trackers and teach the kids about sleep, and then when those kids are in college 10 years later, they know how to get back on track after an all-nighter or after they push themselves too hard in some way. A piece of it's so key, so I'm a big fan of the data-first approach.
Dr. Dan Stickler: For sure.
Dr. Andrew Hill: There's our soapbox. Thank you so much for the time today, sir. Appreciate it.
Dr. Dan Stickler: Yeah, thank you for being on. I appreciate it as usual.
Dr. Andrew Hill: Definitely.
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